Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R202023 | MD |
NPI | 1063976793 |
---|---|
Provider Name | Mrs. Kimberly Lynn Moreland |
First Address | Bel Air, MD 21015-2028 |
Second Address | Bel Air, MD 21014-4393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 06/02/2019 |