Healthcare Provider Details

I. General information

NPI: 1841656980
Provider Name (Legal Business Name): KARI JEAN MOELLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71687 HIGHWAY 111 STE 101
RANCHO MIRAGE CA
92270-4515
US

IV. Provider business mailing address

72047 DINAH SHORE DR STE C4
RANCHO MIRAGE CA
92270-1783
US

V. Phone/Fax

Practice location:
  • Phone: 760-341-0772
  • Fax:
Mailing address:
  • Phone: 760-770-7600
  • Fax: 760-770-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number95003609
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: