MEDICARE: KENNETH MICHAEL MORELAND AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	0027233	OH

General Provider Information

NPI Number	:	1104433036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MICHAEL MORELAND AGACNP-BC

Provider Business Mailing Address
First Line	:	6824 LINBROOK BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5117
Country	:	US
Telephone Number	:	614-937-7401
Fax Number	:

Provider Business Practice Location Address
First Line	:	6824 LINBROOK BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5117
Country	:	US
Telephone Number	:	614-937-7401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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