| NPI | 1659868107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENQUISHA MARIE MOORMAN Ap RN 502-417-3044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3012039) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |