Kelly Moore, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

9351074 Issued in FL

Practice address

3919 Riga Blvd
Tampa, FL 33619-1345

Phone

(813) 558-9500

NPI assigned

Jan 25, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Age Rejuvenation Medical, P.a.

  • Family Medicine Physician
  • Winter Park, FL
  • NPI 1801603717
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1134424906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S BAYSHORE BLVD STE 43",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346954028",
            "telephone_number": "812-887-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 RIGA BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336191345",
            "telephone_number": "813-558-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7100 Raggard Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402161287",
            "country_code": "US",
            "telephone_number": "502-736-9977",
            "fax_number": "502-736-9978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 N Howard Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336061529",
            "country_code": "US",
            "telephone_number": "813-558-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9351074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay Winston Moore, PH.D., FACMG
• Jerrica Chambers Moore, PA-C
• Joanne Marie Moore
• Jonette Rae Moore, ARNP
• Joyce Marie Moore, APRN, FNP-C
• Kelsey Alexandra Moore
• Kimberly Diane Moore, MS CCCSLP
• Lamya Moore
• Marissa Lynn Moore
• Mary F Moore

• Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.