Healthcare Provider Details

I. General information

NPI: 1336126515
Provider Name (Legal Business Name): JAMES E MCKIERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 KRESGE WAY SUITE 56
LOUISVILLE KY
40207-4660
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-7265
  • Fax: 502-897-2113
Mailing address:
  • Phone: 502-238-2801
  • Fax: 502-238-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18531
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number18531
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: