Individual
LYDIA GRACE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1006 NEW MOODY LN, LA GRANGE, KY 40031-9122
(502) 222-0028
(502) 222-0029
Mailing address
1006 NEW MOODY LN, LA GRANGE, KY 40031-9122
(502) 222-0028
(502) 222-0029
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC069
KY
Other
Enumeration date
11/20/2008
Last updated
11/20/2008
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