Provider Demographics
NPI:1336126515
Name:MCKIERNAN, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MCKIERNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-238-2835
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 56
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-895-7265
Practice Address - Fax:502-897-2113
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY185312084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64185317Medicaid
KY2432390000OtherPASSPORT ADVANTAGE
KY1049109OtherPASSPORT
IN100373820Medicaid
KYP00719572OtherRAILTOAD MEDICARE
KY000000617819OtherANTHEM
KY1049109OtherPASSPORT
IN100373820Medicaid
KY00162066Medicare PIN