Provider Demographics
NPI:1245842566
Name:GARRETT, DANA MICHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9647
Mailing Address - Country:US
Mailing Address - Phone:270-402-7453
Mailing Address - Fax:270-789-6119
Practice Address - Street 1:67 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9647
Practice Address - Country:US
Practice Address - Phone:270-402-7453
Practice Address - Fax:270-789-6119
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily