Healthcare Provider Details

I. General information

NPI: 1497842009
Provider Name (Legal Business Name): QUENTIN MOORE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 DOVE RUN RD
LEXINGTON KY
40502-3536
US

IV. Provider business mailing address

1055 DOVE RUN RD SUITE 200
LEXINGTON KY
40502-3536
US

V. Phone/Fax

Practice location:
  • Phone: 859-269-4668
  • Fax: 859-266-5577
Mailing address:
  • Phone: 859-268-0061
  • Fax: 859-266-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1051982
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4172P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: