Organization
PROSPECT PEDIATRICS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERENCE P MCKENNA M.D. (PRESIDENT)
(502) 228-1312
Entity
Organization
Contact information
Practice address
9217 US HIGHWAY 42, PROSPECT, KY 40059-8858
(502) 228-1312
(502) 753-2998
Mailing address
9217 US HIGHWAY 42, PROSPECT, KY 40059-8858
(502) 228-1312
(502) 753-2998
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65914376000
—
KY
Enumeration date
01/09/2007
Last updated
08/22/2020
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