Provider Demographics
NPI:1194027243
Name:MOORE, KERRY E (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW CAMPUS DR
Mailing Address - Street 2:SUNY COLLEGE AT BROCKPORT HAZEN HEALTH CENTER
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2997
Mailing Address - Country:US
Mailing Address - Phone:585-395-2414
Mailing Address - Fax:585-395-2559
Practice Address - Street 1:6 DUPONT CIR NW # 1347
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1108
Practice Address - Country:US
Practice Address - Phone:202-785-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1063076363LF0000X
NY336292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily