Kelly Moore

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

162387 Issued in AK

Practice address

101 W 16TH St # 1128
Yuma, AZ 85364-4733

Phone

(907) 931-8618

NPI assigned

Mar 19, 2015

Last updated

Nov 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Boretide Behavioral Health, LLC

  • Adult Mental Health Clinic/Center
  • Anchorage, AK
  • NPI 1225747215
  NPD Authorized official
• State of Alaska Department of Administration

  dba Alaska Psychiatric Institute

  • Psychiatric Hospital
  • Anchorage, AK
  • NPI 1497842553
  NPD (past)
• State of Alaska Public Health Nursing

  • Community/Behavioral Health Agency
  • Ketchikan, AK
  • NPI 1346601457
  NPD (past)

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1770977563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 16TH ST # 1128",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644733",
            "telephone_number": "907-931-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 16TH ST # 1128",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644733",
            "telephone_number": "907-931-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-19",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "162387",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "37437",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delia Carmen Montopoli, NP, CNM
• Jose Montoya
• James Frank Moon, M.D.
• Moonflower Pediatric Therapies, LLC
• Christopher R Moor, PC
• Michall Alan Moore, MED, MED, LAC, NCC
• Nicole Moore, RN
• Ray Moore
• Teresa Moore, MED
• Walter H. Moore, BS PHARM

• Psychiatric/Mental Health Nurse Practitioner in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; 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.