Individual
MS. JESSICA BROOKE PRAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1111 RING RD, SUITE 100, ELIZABETHTOWN, KY 42701-4900
(270) 706-5515
(270) 706-5516
Mailing address
PO BOX 2309, ELIZABETHTOWN, KY 42702-2309
(270) 706-5515
(270) 706-5516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100255980
—
KY
Enumeration date
10/24/2012
Last updated
09/19/2016
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