Provider Demographics
NPI:1972608461
Name:MOSCOE, JANE GREENFIELD (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:GREENFIELD
Last Name:MOSCOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-9775
Mailing Address - Country:US
Mailing Address - Phone:859-858-2814
Mailing Address - Fax:859-258-8610
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9775
Practice Address - Country:US
Practice Address - Phone:859-858-2814
Practice Address - Fax:859-258-8610
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA017363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00012192OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY95000170Medicaid
KY4000501OtherMEDICARE LAB GROUP
CB5773OtherRR MEDICARE GROUP
KY95000170Medicaid
S52791Medicare UPIN