NPIMap

Individual provider Active NPI

Stephanie T Moore, PA-C

  • Physician Assistant
  • Nicholasville, KY
National Provider Identifier
1356082390
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3105 Issued in KY
Practice address
110 Village Pkwy
Nicholasville, KY 40356-2327
Phone
(859) 887-8400
Fax
(859) 885-8448
NPI assigned
Apr 5, 2022
Last updated
Feb 4, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA3105 KY Primary
Medical Physician Assistant 363AM0700X PA3105 KY
Surgical Physician Assistant 363AS0400X PA3105 KY

Addresses

Primary practice location

110 Village Pkwy
Nicholasville, KY 40356-2327

Mailing address

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6200

Other practice location 1

245 Fountain Ct Ste 120
Lexington, KY 40509-2792
Phone (859) 218-2626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220929002778 KY Practitioner - Physician Assistant 9436535333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Kentucky College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of KentuckyGroup PAC ID 3072425289, 778 clinicians

Practice addresses (Care Compare)

245 Fountain Court
Lexington, KY 40509
Phone (859) 323-6021

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA3105KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New Lexington Clinic PSC CurrentSince Oct 24, 2022 Accepting new patients
New Lexington Clinic, PSC CurrentSince Oct 24, 2022 Accepting new patients
University of Kentucky CurrentSince Feb 12, 2026 Accepting new patients

Locations

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

245 Fountain Ct
Lexington, KY 40509
Phone (859) 323-6021

245 Fountain Ct
Ste 120
Lexington, KY 40509
Phone (859) 218-2626

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

110 Village Pkwy
Nicholasville, KY 40356
Phone (859) 887-2484

Interoperability endpoints

  • Direct secure messaging: stephanie.moore.1@13059.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1356082390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6200",
            "fax_number": "859-258-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 VILLAGE PKWY",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403562327",
            "telephone_number": "859-887-8400",
            "fax_number": "859-885-8448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 Fountain Ct Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405092792",
            "country_code": "US",
            "telephone_number": "859-218-2626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHANIE",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA3105",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA3105",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA3105",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nicholasville, KY

Sources for this page

Verify at the official NPI Registry.