Provider Demographics
NPI:1346480696
Name:MOFFETT, CAROL D (ATP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:D
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 BEASLEY ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4131
Mailing Address - Country:US
Mailing Address - Phone:859-294-4343
Mailing Address - Fax:859-294-0704
Practice Address - Street 1:961 BEASLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4131
Practice Address - Country:US
Practice Address - Phone:859-294-4343
Practice Address - Fax:859-294-0704
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other