Kevin Nelson Moore, PMHNP-BC, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71008478A Issued in IN

Practice address

501 S Madison St Ste 105
Bloomington, IN 47403-2452

Phone

(812) 340-5447

Fax

(888) 789-8394

NPI assigned

Jun 5, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1710479753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S MADISON ST STE 105",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032452",
            "telephone_number": "812-340-5547",
            "fax_number": "888-789-8394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S MADISON ST STE 105",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032452",
            "telephone_number": "812-340-5447",
            "fax_number": "888-789-8394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1531 13th St Ste 2520",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "IN",
            "postal_code": "472011312",
            "country_code": "US",
            "telephone_number": "812-376-6501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 S Adams St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "47403",
            "country_code": "US",
            "telephone_number": "812-333-6324",
            "fax_number": "812-331-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEVIN",
        "middle_name": "NELSON",
        "credential": "PMHNP-BC, APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-02-21",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71008478A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoore@stonebeltmilestone.direct.emds.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "550 S Adams St",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "47403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoore@stonebeltmilestone.direct.emds.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1531 13th St Ste 2520",
            "city": "Columbus",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472011312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtney L Moore, NP
• Gaven Andrew Moore, PA-C
• James Moore, PHARMD
• Joshua Moore, RBT
• Kelsi Moore
• Kevin T. Moore, M.D.
• Noah Moore
• Scot B Moore, MD
• Shannon Kenneth Moore, DMD MSED
• Stephen G Moore, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.