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General NPI Number Information
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NPI Number | 1215896642
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Entity Type | Individual
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Provider Name | KIERSTEN MOORE PA-S2
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Gender | Female
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 8000 YORK RD STE 4100B
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City | TOWSON
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State | MD
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Zip | 21252-0002
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Country | US
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Telephone | 410-704-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 HAYFIELD DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2422
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Country | US
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Telephone | 443-510-7300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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