Provider Demographics
NPI:1497842009
Name:MOORE, QUENTIN (ARNP)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 DOVE RUN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3536
Mailing Address - Country:US
Mailing Address - Phone:859-268-0061
Mailing Address - Fax:859-266-1152
Practice Address - Street 1:1055 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3536
Practice Address - Country:US
Practice Address - Phone:859-269-4668
Practice Address - Fax:859-266-5577
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1051982163W00000X
KY4172P363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013703Medicaid
KYQ22439Medicare UPIN
KY0692929Medicare ID - Type Unspecified
KY0905221Medicare ID - Type Unspecified
KY78013703Medicaid