Healthcare Provider Details

I. General information

NPI: 1518001437
Provider Name (Legal Business Name): PEDIATRIC AND NEONATAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 DUTCHMANS LN STE 410
LOUISVILLE KY
40207-4733
US

IV. Provider business mailing address

4123 DUTCHMANS LN STE 410
LOUISVILLE KY
40207-4733
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-5502
  • Fax: 502-969-8378
Mailing address:
  • Phone: 502-893-5502
  • Fax: 502-969-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50935
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA OSBORNE
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 502-777-2903