Individual
MRS. MELANIE DAWN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207-4201
(502) 855-7200
(502) 855-7201
Mailing address
223 EXECUTIVE PARK, LOUISVILLE, KY 40207-4202
(502) 907-0356
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3007505
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300035632
—
IN
05
—
7100654320
—
KY
Enumeration date
09/24/2012
Last updated
10/28/2020
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