Individual
DR. KELLEY E MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1320 N UNIVERSITY DR STE B, NACOGDOCHES, TX 75961-4270
(936) 559-9225
(936) 559-9701
Mailing address
1320 N UNIVERSITY DR STE B, NACOGDOCHES, TX 75961-4270
(936) 559-9225
(936) 559-9701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L4067
TX
261Q00000X
Clinic/Center
Primary
L4067
TX
Other
Enumeration date
07/11/2006
Last updated
01/21/2026
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