Individual
JULIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 INTERSTATE DR, GRAYSON, KY 41143-1768
(606) 474-5151
(606) 475-3219
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000488374 NONPAR
ANTHEM BCBS
—
05
—
30610026
—
KY
Enumeration date
06/24/2008
Last updated
09/07/2011
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