Kelly Diane Moore, RN

Primary specialty

School Registered NurseTaxonomy code 163WS0200X

License

224481 Issued in AZ

Practice address

701 N Carmichael Ave
Sierra Vista, AZ 85635-1160

Phone

(520) 515-2950

NPI assigned

Aug 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Diane Moore Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1700552007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N CARMICHAEL AVE",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856351160",
            "telephone_number": "520-515-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N CARMICHAEL AVE",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856351160",
            "telephone_number": "520-515-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "middle_name": "DIANE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "AZ",
            "license": "224481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MOORE",
            "middle_name": "DIANE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jenny L Montague, LSCW MSW
• Elanie Montano, COTA/L
• Eduardo Montes, DPM
• Haven Moo
• Alyssa Moon, MS CCC-SLP
• Michael J Moore, M.D.
• Sharika V Moore
• Morgan Evershed DDS, PLLC
• Nicole Michelle Morris, AUD.
• Lisa M Morrison, LCSW, CADC

• All providers in Sierra Vista, AZ
• School Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.