Provider Demographics
NPI:1558257436
Name:MOSS, KATHY LYNN (APRN, PMHNP, B-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN, PMHNP, B-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 JOE ACREE RD
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8517
Mailing Address - Country:US
Mailing Address - Phone:270-579-1471
Mailing Address - Fax:
Practice Address - Street 1:293 JOE ACREE RD
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8517
Practice Address - Country:US
Practice Address - Phone:270-579-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4041606363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty