Provider Demographics
NPI:1609872449
Name:MOORE, EMILY ANNE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:340 CHAPEZE LN
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8893
Mailing Address - Country:US
Mailing Address - Phone:502-921-2963
Mailing Address - Fax:502-921-2963
Practice Address - Street 1:340 CHAPEZE LN
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8893
Practice Address - Country:US
Practice Address - Phone:502-264-1114
Practice Address - Fax:502-921-2963
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4234P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner