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General NPI Number Information
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NPI Number | 1659948438
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Entity Type | Individual
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Provider Name | KELLY MOEDER MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 2509 CANTERBURY DR
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City | HAYS
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State | KS
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Zip | 67601-2233
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Country | US
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Telephone | 785-623-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 CANTERBURY DR
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City | HAYS
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State | KS
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Zip | 67601-2370
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Country | US
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Telephone | 785-623-2254
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-51057
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 04-51057
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License Number State | KS
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