Healthcare Provider Details

I. General information

NPI: 1649979329
Provider Name (Legal Business Name): MOORE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E 62ND AVE
SPOKANE WA
99223-6806
US

IV. Provider business mailing address

PO BOX 30001
SPOKANE WA
99223-3000
US

V. Phone/Fax

Practice location:
  • Phone: 509-903-8766
  • Fax: 509-931-0491
Mailing address:
  • Phone: 509-903-8766
  • Fax: 509-931-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN MARIE-KIESER MOORE
Title or Position: OWNER
Credential: DNP
Phone: 509-993-8585