Individual
KELLY MOORE KANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNPC-AG
Contact information
Practice address
1139 E SONTERRA BLVD, SAN ANTONIO, TX 78258-4347
(210) 638-2000
Mailing address
7700 FLOYD CURL DR, SAN ANTONIO, TX 78229-3902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP129551
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP129551
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
353523906
—
TX
01
—
728198
MEDICARE PTAN
TX
01
—
8JZ357
BCBS
TX
Enumeration date
11/05/2015
Last updated
12/30/2021
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