Provider Demographics
NPI:1114281730
Name:MORENO, KIERSTEN M (MD)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:M
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 E 39TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8324
Mailing Address - Country:US
Mailing Address - Phone:816-478-0220
Mailing Address - Fax:816-795-3456
Practice Address - Street 1:19500 E 39TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8324
Practice Address - Country:US
Practice Address - Phone:816-478-0220
Practice Address - Fax:816-795-3456
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology