Basic Information
| Provider Information | |||||||||
| NPI: | 1396781431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARTH | ||||||||
| FirstName: | KATY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PEEBLES | ||||||||
| OtherFirstName: | KATY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 SOUTH 8TH ST | ||||||||
| Address2: | STE 301E | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621566 | ||||||||
| FaxNumber: | 2707621584 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SOUTH 8TH ST | ||||||||
| Address2: | STE 301E | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621566 | ||||||||
| FaxNumber: | 2707621584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 12/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1918P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7800262300 | 05 | KY | MEDICAID | 000000370089 | 01 | KY | BCBS KY | OTHER |