Active NPI
Kailey Lynn Moore
- Pharmacist
- Idaho Falls, ID
National Provider Identifier
1013402809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P8030
- Practice address
- 376 West 18TH Street
Idaho Falls, ID 83402 - Phone
- (208) 681-8233
- NPI assigned
- Jun 25, 2018
- Last updated
- Jun 25, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P8030 | ID | Primary |
Addresses
Primary practice location
376 West 18TH Street
Idaho Falls, ID 83402
Mailing address
376 W 18TH St
Idaho Falls, ID 83402-4445
Phone (208) 681-8233
Other practice location 1
3475 E 17th St
Ammon, ID 83406-6781
Phone (208) 227-5083
Other practice location 2
1604 W Broadway St
Idaho Falls, ID 83402-3048
Phone (208) 522-4655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P8030 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529884800000",
"number": "1013402809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "376 W 18TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834024445",
"telephone_number": "208-681-8233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "376 WEST 18TH STREET",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "83402",
"telephone_number": "208-681-8233"
}
],
"practiceLocations": [
{
"address_1": "3475 E 17th St",
"address_purpose": "LOCATION",
"city": "Ammon",
"state": "ID",
"postal_code": "834066781",
"country_code": "US",
"telephone_number": "208-227-5083",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1604 W Broadway St",
"address_purpose": "LOCATION",
"city": "Idaho Falls",
"state": "ID",
"postal_code": "834023048",
"country_code": "US",
"telephone_number": "208-522-4655",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "KAILEY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-25",
"last_updated": "2018-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P8030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.