Provider Demographics
NPI:1265621247
Name:DE MOISEY, JAN (RN, MSN, MBA)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:DE MOISEY
Suffix:
Gender:F
Credentials:RN, MSN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LANDMARK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1354
Mailing Address - Country:US
Mailing Address - Phone:859-261-3700
Mailing Address - Fax:859-261-9788
Practice Address - Street 1:7370 TURFWAY RD
Practice Address - Street 2:STE 350
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-212-4889
Practice Address - Fax:859-212-4890
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1038342163WP0809X
KY5238P163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1038342OtherKY BD OF LIC