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Individual

KENNETH E MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA C

Contact information

Practice address
1313 N 13TH AVE, WALLA WALLA, WA 99362-8817
(509) 200-2852
(509) 522-5899
Mailing address
615 UNIVERSITY ST, WALLA WALLA, WA 99362-2338
(509) 200-2852

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003031
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1081678
WA
Enumeration date
08/21/2006
Last updated
06/30/2009
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