Kimberly Moore, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

3155-39 Issued in WI

Practice address

1970 S Ridge Rd
Green Bay, WI 54304-4125

Phone

(920) 430-4888

NPI assigned

May 13, 2024

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1477301604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 MADISON WAY APT 5",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541663872",
            "telephone_number": "210-379-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044125",
            "telephone_number": "920-430-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KIMBERLY",
        "credential": "LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "3155-39",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Fernando Monroy Chaves, MD
• Michelle Montesinos
• Charles E Montoure, DDS MS
• Moon Counseling LLC
• Kelsey Moon, MA, LPC
• Terry J Moore, MD
• Melissa Ann Mooren
• Moraine Ridge LLC
• Edward Andrew Morales, MD
• Patrick Moran, MD

• Athletic Trainer in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.