MEDICARE: DR. JESSICA MUTTERS-MORALES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	06019	KY

General Provider Information

NPI Number	:	1316697261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MUTTERS-MORALES DO

Provider Business Mailing Address
First Line	:	4117 BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1535
Country	:	US
Telephone Number	:	630-805-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1535
Country	:	US
Telephone Number	:	502-452-6337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	06/10/2025

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