Active NPI
Moise Kelly
- Community Health Worker
- Mesa, AZ
National Provider Identifier
1447640958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 957399
- Practice address
- 455 S Mesa Dr Unit 142
Mesa, AZ 85210-2711 - Phone
- (480) 277-0313
- NPI assigned
- Feb 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 957399 | AZ | |
| Social Worker | 104100000X | 957399 | AZ | |
| Case Manager/Care Coordinator | 171M00000X | 957399 | AZ | |
| Health Educator | 174H00000X | 957399 | AZ | |
| Community Health Worker | 172V00000X | 957399 | AZ | Primary |
Addresses
Primary practice location
455 S Mesa Dr Unit 142
Mesa, AZ 85210-2711
Mailing address
455 S Mesa Dr Unit 142
Mesa, AZ 85210-2711
Phone (480) 616-3323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 957399 | Medicaid | AZ |
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 |
|---|---|---|---|
| 957399 | AZ | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563235200000",
"number": "1447640958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 S MESA DR UNIT 142",
"city": "MESA",
"state": "AZ",
"postal_code": "852102711",
"telephone_number": "480-616-3323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 S MESA DR UNIT 142",
"city": "MESA",
"state": "AZ",
"postal_code": "852102711",
"telephone_number": "480-277-0313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MOISE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-04",
"last_updated": "2019-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "957399",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AZ",
"license": "957399",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "AZ",
"license": "957399",
"primary": false
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "AZ",
"license": "957399",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AZ",
"license": "957399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "957399",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.