Provider Demographics
NPI:1003432618
Name:MOORE, KIMBERLY A
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 KWIGUK STREET
Mailing Address - Street 2:
Mailing Address - City:EMMONAK
Mailing Address - State:AK
Mailing Address - Zip Code:99581
Mailing Address - Country:US
Mailing Address - Phone:907-949-3500
Mailing Address - Fax:907-949-3541
Practice Address - Street 1:215 KWIGUK STREET
Practice Address - Street 2:
Practice Address - City:EMMONAK
Practice Address - State:AK
Practice Address - Zip Code:99581
Practice Address - Country:US
Practice Address - Phone:907-949-3500
Practice Address - Fax:907-949-3541
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker