Individual
KELLY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
7101 JAHNKE RD, RICHMOND, VA 23225-4017
(804) 483-0000
Mailing address
2555 PROVIDENCE CREEK RD, NORTH CHESTERFIELD, VA 23236-5234
(610) 213-5094
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001251579
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024186301
VA
Other
Enumeration date
03/04/2022
Last updated
03/10/2023
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