Individual
KELLY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 W 16TH ST # 1128, YUMA, AZ 85364-4733
(907) 931-8618
Mailing address
101 W 16TH ST # 1128, YUMA, AZ 85364-4733
(907) 931-8618
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
37437
AK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
162387
AK
Other
Enumeration date
03/19/2015
Last updated
11/22/2022
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