Provider Demographics
NPI:1083985626
Name:MOYER, KELLEY MARIE
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:MARIE
Last Name:MOYER
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 1:702 FAYE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437-9597
Mailing Address - Country:US
Mailing Address - Phone:870-919-4271
Mailing Address - Fax:
Practice Address - Street 1:702 FAYE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-9597
Practice Address - Country:US
Practice Address - Phone:870-919-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant