NPIMap

Individual provider Active NPI

Keaton Dalaina Moore, PA-C

  • Physician Assistant
  • South Charleston, WV
National Provider Identifier
1548016488
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3034 Issued in WV
Practice address
509 2ND Ave
South Charleston, WV 25303-1310
Phone
(304) 720-3555
Fax
(304) 720-3556
NPI assigned
Apr 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3034 WV Primary

Addresses

Primary practice location

509 2ND Ave
South Charleston, WV 25303-1310

Mailing address

509 2ND Ave
South Charleston, WV 25303-1310
Phone (304) 720-3555

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address keaton.moore.1@17156.direct.athenahealth.com Family Health Associates of the Kanawha Valley, PLLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240806002565 WV Practitioner - Physician Assistant 8325585532 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Health Associates of the Kanawha Valley PLLCGroup PAC ID 2466553391, 6 clinicians

Practice addresses (Care Compare)

509 2ND Ave
South Charleston, WV 25303-1310
Phone (304) 720-3555

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2894WVMDProfessional Counselor
3034WVMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1548016488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 2ND AVE",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031310",
            "telephone_number": "304-720-3555",
            "fax_number": "304-720-3556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 2ND AVE",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031310",
            "telephone_number": "304-720-3555",
            "fax_number": "304-720-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEATON",
        "middle_name": "DALAINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-29",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "3034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keaton.moore.1@17156.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "Family Health Associates of the Kanawha Valley, PLLC",
            "address_1": "509 2nd Ave",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253031310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.