Healthcare Provider Details

I. General information

NPI: 1407746449
Provider Name (Legal Business Name): MAKAYLA HAWKINS MOYNAGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 TETON TRL
FRANKFORT KY
40601-1759
US

IV. Provider business mailing address

312 BRIDLEWOOD AVE
SHELBYVILLE KY
40065-7209
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-5173
  • Fax:
Mailing address:
  • Phone: 502-320-0814
  • Fax: 502-490-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4038798
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: