Individual
STEPHANIE T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
110 VILLAGE PKWY, NICHOLASVILLE, KY 40356-2327
(859) 887-8400
(859) 885-8448
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3105
KY
363AM0700X
Medical Physician Assistant
PA3105
KY
363AS0400X
Surgical Physician Assistant
PA3105
KY
Other
Enumeration date
04/05/2022
Last updated
02/04/2026
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