Provider Demographics
NPI:1154306207
Name:PRESTON, HENRY R (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 LEXINGTON ROAD SUITE 130
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324
Mailing Address - Country:US
Mailing Address - Phone:502-867-0222
Mailing Address - Fax:502-867-0420
Practice Address - Street 1:1138 LEXINGTON ROAD SUITE 130
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-867-0222
Practice Address - Fax:502-867-0420
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31821207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64318215Medicaid
F79328Medicare UPIN
KY64318215Medicaid