Provider Demographics
NPI:1053349456
Name:GARNER, KAMARA EVETTE (MD)
Entity type:Individual
Prefix:
First Name:KAMARA
Middle Name:EVETTE
Last Name:GARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-937-3864
Mailing Address - Fax:502-937-1237
Practice Address - Street 1:6801 DIXIE HWY
Practice Address - Street 2:STE 133
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3913
Practice Address - Country:US
Practice Address - Phone:502-937-3864
Practice Address - Fax:502-937-1237
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64120314Medicaid
KYP00835175Medicare PIN
KYP400016232Medicare Oscar/Certification
I47593Medicare UPIN
0980813Medicare ID - Type Unspecified