Healthcare Provider Details

I. General information

NPI: 1679084305
Provider Name (Legal Business Name): KELSEY GRACE MOORE MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33501 1ST WAY S
FEDERAL WAY WA
98003-6208
US

IV. Provider business mailing address

33501 1ST WAY S
FEDERAL WAY WA
98003-6208
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-2400
  • Fax:
Mailing address:
  • Phone: 253-838-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60801877
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60801877
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-214565
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: