Individual
DENISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4102 DEER RUN RD, CRESTWOOD, KY 40014-9227
(502) 758-0795
Mailing address
4102 DEER RUN RD, CRESTWOOD, KY 40014-9227
(502) 758-0795
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3013070
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300029799
—
IN
05
—
7100620180
—
KY
Enumeration date
02/03/2019
Last updated
07/23/2024
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