Individual
KEVIN NELSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC, APRN
Contact information
Practice address
501 S MADISON ST STE 105, BLOOMINGTON, IN 47403-2452
(812) 340-5447
(888) 789-8394
Mailing address
501 S MADISON ST STE 105, BLOOMINGTON, IN 47403-2452
(812) 340-5547
(888) 789-8394
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71008478A
IN
Other
Enumeration date
06/05/2018
Last updated
02/21/2024
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