1265621247 NPI number — MS. JAN DE MOISEY RN, MSN, MBA

Table of content: MS. JAN DE MOISEY RN, MSN, MBA (NPI 1265621247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265621247 NPI number — MS. JAN DE MOISEY RN, MSN, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE MOISEY
Provider First Name:
JAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265621247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 LANDMARK DR STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41073-1354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-261-3700
Provider Business Mailing Address Fax Number:
859-261-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7370 TURFWAY RD
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-212-4889
Provider Business Practice Location Address Fax Number:
859-212-4890
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  1038342 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0809X , with the licence number: 5238P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1038342 . This is a "KY BD OF LIC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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