Individual
MRS. KAITLYN E. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-1735
(229) 259-4611
(229) 259-4664
Mailing address
PO BOX 9, VALDOSTA, GA 31603-0009
(229) 259-4611
(229) 259-4664
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN195214
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168986A
—
GA
Enumeration date
10/15/2015
Last updated
11/20/2018
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