Healthcare Provider Details

I. General information

NPI: 1780164368
Provider Name (Legal Business Name): KIM-LY MOBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCGREGOR ST
MANCHESTER NH
03102-3730
US

IV. Provider business mailing address

100 MCGREGOR ST
MANCHESTER NH
03102-3730
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-5310
  • Fax: 603-663-8015
Mailing address:
  • Phone: 603-663-5310
  • Fax: 603-663-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number059669-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: