Active NPI
Kelly Moffatt
- Counselor
- Saint Louis, MO
National Provider Identifier
1982448080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 20130011673
- Practice address
- 4055 Laclede Ave Apt 312
Saint Louis, MO 63108-3255 - Phone
- (314) 324-6792
- NPI assigned
- Jun 24, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 20130011673 | MO | Primary |
Addresses
Primary practice location
4055 Laclede Ave Apt 312
Saint Louis, MO 63108-3255
Mailing address
4055 Laclede Ave Apt 312
Saint Louis, MO 63108-3255
Phone (314) 324-6792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20130011673 | MO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1982448080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4055 LACLEDE AVE APT 312",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631083255",
"telephone_number": "314-324-6792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 LACLEDE AVE APT 312",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631083255",
"telephone_number": "314-324-6792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFATT",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-24",
"last_updated": "2024-06-24",
"certification_date": "2024-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "20130011673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.