Healthcare Provider Details

I. General information

NPI: 1285467613
Provider Name (Legal Business Name): KIMBERLEY TATUM MOYER WHNP IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY ANNE TATUM-MOYER WHNP IBCLC

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 10/30/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE AVE
HILO HI
96720-2089
US

IV. Provider business mailing address

214 BLUEFIELD RD
CHAPEL HILL NC
27517-7002
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3797
  • Fax:
Mailing address:
  • Phone: 970-986-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN-4777-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: