Healthcare Provider Details

I. General information

NPI: 1083854731
Provider Name (Legal Business Name): MEADE COUNTY PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAWRENCE STREET
BRANDENBURG KY
40108-1401
US

IV. Provider business mailing address

1010 LAWRENCE STREET
BRANDENBURG KY
40108-1401
US

V. Phone/Fax

Practice location:
  • Phone: 270-422-3400
  • Fax:
Mailing address:
  • Phone: 270-422-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L. KUPPER
Title or Position: OWNER
Credential:
Phone: 270-422-3400