Holly Kay Moore, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP1098A Issued in ID

Practice address

3320 N Grand Mill LN
Coeur D Alene, ID 83814-5689

Phone

(208) 765-9100

Fax

(208) 765-9103

NPI assigned

Sep 20, 2011

Last updated

Feb 23, 2023By the provider in NPPES

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2023 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: hmoore627381@direct.multicare.org
• FHIR API: https://api.platform.athenahealth.com/6242/brand/1/csg/1/fhir/r4

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.

• North Idaho Lung, Asthma and Critical Care, LLC.

  • Pulmonary Disease Physician
  • Coeur d'Alene, ID
  • NPI 1932464989
  NPD (past)
• Inland Cardiology Associates, P.S.

  • Cardiovascular Disease Physician
  • Spokane, WA
  • NPI 1679522106
  NPD (past)

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1295018968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 N GRAND MILL LN",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145689",
            "telephone_number": "208-765-9100",
            "fax_number": "208-765-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 N GRAND MILL LN",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145689",
            "telephone_number": "208-765-9100",
            "fax_number": "208-765-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "HOLLY",
        "middle_name": "KAY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-20",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP1098A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jana Marie Montgomery, OTR/L
• Rebecca Elizabeth Montgomery
• David Ernest Moody, MD
• Laura Moog, LMT
• Christopher Paul Moore, CPO
• Kala Marie Moore, LMP
• Kerri Ann Moore
• Kevin Dwayne Moore, PTA
• Rebecca Moore
• Charles A Moores, CRNA

• Nurse Practitioner in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.