MEDICARE: DR. COLLEEN MARIE-KIESER MOORE DNP, APRN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202208557NP-PP	OR
2	363L00000X	Nurse Practitioner	AP60919281	WA
3	363LG0600X	Gerontology Nurse Practitioner	AP60919281	WA
4	363L00000X	Nurse Practitioner	202208557NP-PP	OR
5	363LA2200X	Adult Health Nurse Practitioner	AP60158260	WA
6	363LP2300X	Primary Care Nurse Practitioner	AP60919281	WA
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60919281	WA

General Provider Information

NPI Number	:	1720569593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN MARIE-KIESER MOORE DNP, APRN

Provider Business Mailing Address
First Line	:	PO BOX 30001
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3000
Country	:	US
Telephone Number	:	509-903-8766
Fax Number	:	509-931-0491

Provider Business Practice Location Address
First Line	:	PO BOX 30001
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3000
Country	:	US
Telephone Number	:	509-903-8766
Fax Number	:	509-931-0491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	06/04/2026

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