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NPI Code Detail

MEDICARE: MRS. KELLEY ANN MOORE-SOUTH

MEDICARE: MRS. KELLEY ANN MOORE-SOUTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427254614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLEY ANN MOORE-SOUTH
Provider Business Mailing Address
First Line : 1579 RUSSELL DR
Second Line :
City : STREETSBORO
State : OH
Zip : 44241-8349
Country : US
Telephone Number : 330-422-1304
Fax Number :
Provider Business Practice Location Address
First Line : 1645 MAPLEWOOD DR
Second Line :
City : STREETSBORO
State : OH
Zip : 44241-5662
Country : US
Telephone Number : 330-626-3031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. KELLEY ANN MOORE-SOUTH ” Practice Location

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