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NPI Code Detail

MEDICARE: KEVIN NELSON MOORE PMHNP-BC, APRN

MEDICARE: KEVIN NELSON MOORE PMHNP-BC, APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner71008478AIN

General Provider Information

NPI Number : 1710479753
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN NELSON MOORE PMHNP-BC, APRN
Provider Business Mailing Address
First Line : 501 S MADISON ST STE 105
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2452
Country : US
Telephone Number : 812-340-5547
Fax Number : 888-789-8394
Provider Business Practice Location Address
First Line : 501 S MADISON ST STE 105
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2452
Country : US
Telephone Number : 812-340-5447
Fax Number : 888-789-8394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2018
Last Update Date : 02/21/2024

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