Provider Demographics
NPI:1407859630
Name:LESSENBERRY, BARRET (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRET
Middle Name:
Last Name:LESSENBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 COLUMNS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8068
Mailing Address - Country:US
Mailing Address - Phone:270-651-9390
Mailing Address - Fax:270-651-8698
Practice Address - Street 1:106 COLUMNS PLAZA DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8068
Practice Address - Country:US
Practice Address - Phone:270-651-9390
Practice Address - Fax:270-651-8698
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-03-02
Deactivation Date:2005-05-23
Deactivation Code:
Reactivation Date:2005-06-01
Provider Licenses
StateLicense IDTaxonomies
KY22051173000000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCC1655OtherRAILROAD MEDICARE
KY64220510Medicaid
KY1293702Medicare PIN
KYCC1655OtherRAILROAD MEDICARE
KYD08115Medicare UPIN