Healthcare Provider Details

I. General information

NPI: 1942255963
Provider Name (Legal Business Name): MARCY GALLOW MOYNIHAN ARNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1237 KANNAPOLIS PL
LEXINGTON KY
40513-1244
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-4886
Mailing address:
  • Phone: 859-224-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1051543
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: