Individual
KEYOSHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6927 SKYLINE PARK DR, KATY, TX 77449-4353
(262) 880-6019
Mailing address
6 MCKINLEY AVE, RACINE, WI 53404-3414
(262) 880-6019
(262) 880-6019
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
31-197182
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016649
STATE OF WISCONSIN LISENCE
WI
Enumeration date
12/21/2017
Last updated
12/21/2017
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