Healthcare Provider Details

I. General information

NPI: 1265621247
Provider Name (Legal Business Name): JAN DE MOISEY RN, MSN, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD STE 350
FLORENCE KY
41042
US

IV. Provider business mailing address

103 LANDMARK DR STE 360
BELLEVUE KY
41073-1354
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-4889
  • Fax: 859-212-4890
Mailing address:
  • Phone: 859-261-3700
  • Fax: 859-261-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1038342
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number5238P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: