Kenneth Jerald Moore, PHD LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2165 Issued in OK

Practice address

6906 S Utica PL
Tulsa, OK 74136-5158

Phone

(918) 794-4596

NPI assigned

Oct 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Ken J Moore Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Doctor of Philosophy

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250208000000",
    "number": "1376722348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6906 S UTICA PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365158",
            "telephone_number": "918-794-4596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6906 S UTICA PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365158",
            "telephone_number": "918-794-4596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KENNETH",
        "middle_name": "JERALD",
        "name_prefix": "Dr.",
        "credential": "PHD LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-26",
        "last_updated": "2009-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "2165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEN",
            "last_name": "MOORE",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "PHD, LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kari M Moore, O.D.
• Katherine Ainsley Moore, CNC
• Kathryn Moore, M.S., CCC-SLP
• Katie A Moore
• Katrina Ann Moore, LPN
• Kera Lynn Moore
• Krystal Brittany Moore, LPC-CANDIDATE
• Lauren Jennette Moore, D.O.
• Leslie Ann Moore
• Marissa Opal Moore, LPC

• Clinical Social Worker in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2009; 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.