Individual
KELLY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1401 W PULASKI ST, FORT WORTH, TX 76104-2717
(817) 454-8055
Mailing address
PO BOX 99213, FORT WORTH, TX 76199-0213
(682) 885-1860
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
1011153
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
1011153
TX
Other
Enumeration date
10/26/2020
Last updated
05/06/2021
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