Individual
KIMBERLY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1333 W WASHINGTON ST, STEPHENVILLE, TX 76401-4168
(254) 968-9175
Mailing address
1650 W LINGLEVILLE RD APT 107, STEPHENVILLE, TX 76401-1825
(910) 650-4237
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
AT8208
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZGP529006652
BLUECROSS BLUESHIELD
—
Enumeration date
07/24/2020
Last updated
07/24/2020
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