Individual
BRENDAN MICIANIZL MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2501 LEXINGTON AVE, ASHLAND, KY 41101
(606) 329-0890
(606) 329-0904
Mailing address
PO BOX 513, ASHLAND, KY 41105
(606) 329-0890
(606) 329-0904
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34006
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64340060
—
KY
Enumeration date
11/27/2006
Last updated
07/08/2007
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