Healthcare Provider Details

I. General information

NPI: 1720569593
Provider Name (Legal Business Name): COLLEEN MARIE-KIESER MOORE DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 30001
SPOKANE WA
99223-3000
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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202208557NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60919281
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60919281
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202208557NP-PP
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60158260
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60919281
License Number StateWA
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60919281
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: