Individual
KELLY RENEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
130 ANDOR LN, HILLSBORO, MO 63050-4606
(314) 520-1227
Mailing address
224 MARGARET MICHELLE CT, SAINT PETERS, MO 63376-4812
(314) 520-1227
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2016029955
MO
363LA2200X
Adult Health Nurse Practitioner
209.015105
IL
363LG0600X
Gerontology Nurse Practitioner
2016029955
MO
363LG0600X
Gerontology Nurse Practitioner
209.015105
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780128942
LICENSE
MO
Enumeration date
12/07/2016
Last updated
11/07/2022
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