Provider Demographics
NPI:1083331920
Name:MOSER, KELYN LORRAINE (RN)
Entity Type:Individual
Prefix:
First Name:KELYN
Middle Name:LORRAINE
Last Name:MOSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 COHO CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-3095
Mailing Address - Country:US
Mailing Address - Phone:503-956-8020
Mailing Address - Fax:
Practice Address - Street 1:9427 SW BARNES RD STE 394
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6616
Practice Address - Country:US
Practice Address - Phone:503-297-6511
Practice Address - Fax:503-297-5231
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR036407RN163WS0121X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery