Active NPI
Kelly M Moore, PH.D.
- Psychologist
- Hines, IL
National Provider Identifier
1477960433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071008849
- Practice address
- 5000 S 5TH Ave
Hines, IL 60141-3030 - Phone
- (708) 774-0246
- NPI assigned
- Jul 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071008849 | IL | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines, IL 60141-3030
Mailing address
900 S Clark St Apt 904
Chicago, IL 60605-3686
Phone (719) 648-7617
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071008849 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405987200000",
"number": "1477960433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 S CLARK ST APT 904",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606053686",
"telephone_number": "719-648-7617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "708-774-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KELLY",
"middle_name": "M",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-22",
"last_updated": "2014-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071008849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.