Individual
JACLYN VAUGHN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
234 E GRAY ST STE 164, LOUISVILLE, KY 40202-1903
(502) 629-2405
Mailing address
4804 DEER MEADOW LN, LA GRANGE, KY 40031-6717
(502) 645-9066
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
163224
KY
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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