Individual
JORDAN MYERS PRENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
630 SOUTHPOINT DR, LEXINGTON, KY 40515-6350
(859) 272-1928
(859) 271-9601
Mailing address
630 SOUTHPOINT DR, LEXINGTON, KY 40515-6350
(859) 272-1928
(859) 271-9601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03156
KY
207Q00000X
Family Medicine Physician
R1335
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03156
KY LICENSE
KY
01
—
R1335
KENTUCKY STATE LICENSE
KY
Enumeration date
06/17/2008
Last updated
11/08/2016
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