Provider Demographics
NPI:1376513267
Name:GARRETT, LISETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:MARIE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2786
Mailing Address - Country:US
Mailing Address - Phone:606-678-8155
Mailing Address - Fax:606-678-7548
Practice Address - Street 1:350 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2786
Practice Address - Country:US
Practice Address - Phone:606-678-8155
Practice Address - Fax:606-678-7548
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64345218Medicaid
KY64345218Medicaid