MEDICARE: KIMBERLY MOORE

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	163W00000X	Registered Nurse	861665-01	NY

General Provider Information

NPI Number	:	1568312064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MOORE

Provider Business Mailing Address
First Line	:	2351 STUART ST # 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5813
Country	:	US
Telephone Number	:	718-619-5700
Fax Number	:	718-619-5700

Provider Business Practice Location Address
First Line	:	2351 STUART ST # 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5813
Country	:	US
Telephone Number	:	718-619-5700
Fax Number	:	718-619-5700

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ KIMBERLY MOORE ” Practice Location

Language	Start Address	Practice Location

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