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NPI Code Detail

MEDICARE: KELLY N MOORE MSSW, LCSW

MEDICARE: KELLY N MOORE MSSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker3530KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558401836
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY N MOORE MSSW, LCSW
Provider Business Mailing Address
First Line : 1306 VERSAILLES RD STE 120
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1795
Country : US
Telephone Number : 859-259-2635
Fax Number : 859-254-7874
Provider Business Practice Location Address
First Line : 1306 VERSAILLES RD STE 120
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1795
Country : US
Telephone Number : 859-259-2635
Fax Number : 859-254-7874
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 09/10/2015

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Directions to “ KELLY N MOORE MSSW, LCSW” Practice Location

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