Individual
KIMBERLY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
Mailing address
310 MADISON WAY APT 5, SHAWANO, WI 54166-3872
(210) 379-0999
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3155-39
WI
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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