Kelly Michelle Moore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C8385 Issued in MS

Practice address

301 Fisher Street
Keesler AFB, MS 39534

Phone

(228) 376-0385

NPI assigned

May 16, 2018

Last updated

Feb 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1134619018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FISHER STREET",
            "address_2": "KEESLER AFB MENTAL HEALTH CLINIC",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "39534",
            "telephone_number": "228-376-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FISHER STREET",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "39534",
            "telephone_number": "228-376-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "M8385",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "C8385",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C8385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Martin, IDMT
• Nicole Elizabeth Mayzner, LCSW
• Stephanie Frances McCann, R.D.
• Cynthia Mitchell, RD
• Sheila Kay Mitchell, CRNP
• James Tybirius Morrison, OD
• Maroutcha Mouawad, DO
• Yolanda Michele Moulds-Love, R.PH.
• Francisca Mukete, PHARMD
• James Patrick Nall, D.M.D.

• Clinical Social Worker in Keesler AFB, MS
• Providers in Keesler AFB, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; 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.