Healthcare Provider Details

I. General information

NPI: 1811336423
Provider Name (Legal Business Name): NOMATHAMSANQA MOYO-PETERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S MAIN ST
FRANKLIN KY
42134-2370
US

IV. Provider business mailing address

PO BOX 9519
BOWLING GREEN KY
42102-9519
US

V. Phone/Fax

Practice location:
  • Phone: 270-586-5888
  • Fax: 270-586-0255
Mailing address:
  • Phone: 270-586-5888
  • Fax: 270-586-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: