Individual
MRS. KELLY MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, NP
Contact information
Practice address
550 W SHAWNEE ST, MUSKOGEE, OK 74401-4144
(918) 935-3636
Mailing address
550 W SHAWNEE ST, MUSKOGEE, OK 74401-4144
(918) 910-5186
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
R0109418
OK
363LF0000X
Family Nurse Practitioner
Primary
109418
OK
Other
Enumeration date
04/29/2019
Last updated
03/01/2022
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