Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 065266-23 | NH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 065266-23 | NH |
N | 363LP2300X | Nurse Practitioner - Primary Care | 065266-23 | NH |
NPI | 1477837516 |
---|---|
Provider Name | Kelly Moore |
First Address | Somersworth, NH 03878-1522 |
Second Address | Somersworth, NH 03878-1522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2011 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065266-23 | APRN LICENSE (01) | NH |