Healthcare Provider Details

I. General information

NPI: 1083550784
Provider Name (Legal Business Name): BRADY MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

1511 SOUTHERN SKY CIR
BOWLING GREEN KY
42104-7629
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-1100
  • Fax:
Mailing address:
  • Phone: 270-784-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: