Provider Demographics
NPI:1598766701
Name:GARNER, LAURIE K (PAC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:GARNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CROSSFIELD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1982
Mailing Address - Country:US
Mailing Address - Phone:859-873-9188
Mailing Address - Fax:859-873-0870
Practice Address - Street 1:117 CROSSFIELD DR
Practice Address - Street 2:SUITE B
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1982
Practice Address - Country:US
Practice Address - Phone:859-873-9188
Practice Address - Fax:859-873-0870
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA 524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000931Medicaid
KYK063490Medicare PIN
P08270Medicare UPIN
KY0169Medicare PIN
KY95000931Medicaid