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: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 BULL LEA RD
LEXINGTON KY
40511-1247
US

IV. Provider business mailing address

312 BRIDLEWOOD AVE
SHELBYVILLE KY
40065-7209
US

V. Phone/Fax

Practice location:
  • Phone: 859-246-8000
  • Fax: 859-246-8032
Mailing address:
  • Phone: 502-320-0814
  • Fax:

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: