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Individual

KELLIE MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
MSC10 5590 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-3120
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
RS2015-0351
NM
390200000X
Student in an Organized Health Care Education/Training Program
NM

Other

Enumeration date
03/31/2015
Last updated
06/20/2015
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