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General NPI Number Information
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NPI Number | 1487574570
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Entity Type | Organization
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Legal Business Name | THE KENTUCKY WELLNESS COLLECTIVE
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 618 TETON TRL
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City | FRANKFORT
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State | KY
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Zip | 40601-1759
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Country | US
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Telephone | 502-354-3938
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Fax | 502-490-3860
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Provider Business Mailing Address
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Address Line | 618 TETON TRL
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City | FRANKFORT
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State | KY
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Zip | 40601-1759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAKAYLA MOYNAGH
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Credential | APRN
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Telephone | 502-354-3938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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