Individual
DANIEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, SUITE 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1041947
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
036799
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000537086
ANTHEM
—
05
—
0854713
—
OH
05
—
200877870
—
IN
05
—
74092115
—
KY
Enumeration date
10/31/2005
Last updated
08/28/2012
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