Provider Demographics
NPI:1831391556
Name:WORTHINGTON, GARNET E (LMT)
Entity type:Individual
Prefix:
First Name:GARNET
Middle Name:E
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 KINGSRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-8655
Mailing Address - Country:US
Mailing Address - Phone:502-732-9938
Mailing Address - Fax:502-732-9938
Practice Address - Street 1:1732 KINGSRIDGE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8655
Practice Address - Country:US
Practice Address - Phone:502-732-9938
Practice Address - Fax:502-732-9938
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator