Individual
KELLY JO MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 MAIN ST, MANCHESTER, KY 40962-1259
(606) 596-0323
Mailing address
205 MAIN ST, MANCHESTER, KY 40962-1259
(606) 596-0323
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/19/2022
Last updated
05/19/2022
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