Individual
KRISTA MOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1760 NICHOLASVILLE RD, SUITE 301, LEXINGTON, KY 40503-1471
(859) 260-5527
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4966
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1750
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100315990
—
KY
01
—
P01458492
RR MEDICARE
KY
Enumeration date
10/11/2011
Last updated
12/04/2020
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