Individual
TERESA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
257 PARKLAND HTS, CYNTHIANA, KY 41031-6017
(859) 234-6940
Mailing address
2520 PREWITT PIKE, MT STERLING, KY 40353-8766
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
07/18/2014
Last updated
07/24/2014
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