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NPI Code Detail

MEDICARE: KELLY MOORE

MEDICARE: KELLY 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1891098448
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MOORE
Provider Business Mailing Address
First Line : 619 N 500 W
Second Line :
City : PROVO
State : UT
Zip : 84601-1547
Country : US
Telephone Number : 801-375-4240
Fax Number : 801-375-4241
Provider Business Practice Location Address
First Line : 18750 N 6750 E
Second Line :
City : MOUNT PLEASANT
State : UT
Zip : 84647-2309
Country : US
Telephone Number : 435-462-5491
Fax Number : 435-462-5492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2010
Last Update Date : 12/20/2010

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Directions to “ KELLY MOORE ” Practice Location

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