Provider Demographics
NPI:1083231708
Name:MOORE-AVANT, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MOORE-AVANT
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 1:1231 E 173RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3132
Mailing Address - Country:US
Mailing Address - Phone:216-507-9403
Mailing Address - Fax:
Practice Address - Street 1:1231 E 173RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-3132
Practice Address - Country:US
Practice Address - Phone:216-507-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty