Provider Demographics
NPI:1437138666
Name:MCKENNA, TERENCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:P
Last Name:MCKENNA
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 1:9217 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8858
Mailing Address - Country:US
Mailing Address - Phone:502-228-1312
Mailing Address - Fax:
Practice Address - Street 1:9217 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8858
Practice Address - Country:US
Practice Address - Phone:502-228-1312
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64220428Medicaid
KY1049487OtherPASSPORT
KYC78286Medicare UPIN