Kimberly Mae Miranda Moll Lee

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

Practice address

167 N Main St
Tuba City, AZ 86045

Phone

(928) 283-2754

Fax

(928) 283-2758

NPI assigned

Mar 4, 2022

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1780331231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 THREE CHIMNEYS WAY",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953617781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "928-283-2754",
            "fax_number": "928-283-2758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 Three Chimneys Way",
            "address_purpose": "LOCATION",
            "city": "Oakdale",
            "state": "CA",
            "postal_code": "953617781",
            "country_code": "US",
            "telephone_number": "209-535-7508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLL LEE",
        "first_name": "KIMBERLY MAE",
        "middle_name": "MIRANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-06-06",
        "certification_date": "2022-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Millette, RN
• Brittany Louise Millns, PA-C
• Geraldine Mitchell, RN
• John Leo Moffatt Jr., RN,BSN
• Dayanara Ortiz Molina, RN
• Paul R Moller, DO
• Mirriam Marie Montalvo, RN
• Mark Andrew Moon, R.N.
• Casey Moore
• Shawna Diane Mora, RN

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.