Individual
JESSICA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2330 CONCRETE RD, CARLISLE, KY 40311-9700
(859) 289-7126
Mailing address
2330 CONCRETE RD, CARLISLE, KY 40311-9700
(859) 289-7126
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
201132
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
01
—
184607
MEDICARE GROUP NUMBER
KY
Enumeration date
06/23/2006
Last updated
11/30/2011
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