Healthcare Provider Details

I. General information

NPI: 1124125497
Provider Name (Legal Business Name): PRESCOTT PLASTIC SURGERY & MED SPA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 BUSH RIDGE DR STE B
LOUISVILLE KY
40245-5885
US

IV. Provider business mailing address

2507 BUSH RIDGE DR STE B
LOUISVILLE KY
40245-5885
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8000
  • Fax: 502-589-8001
Mailing address:
  • Phone: 502-589-8000
  • Fax: 502-589-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA PRESCOTT
Title or Position: OWNER/ PROVIDER
Credential: MD
Phone: 502-589-8000