Provider Demographics
NPI:1407048366
Name:MOELLER, KELLIE A (CNM)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:MOELLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4985
Mailing Address - Country:US
Mailing Address - Phone:281-794-6646
Mailing Address - Fax:281-554-2914
Practice Address - Street 1:2401 RICE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3202
Practice Address - Country:US
Practice Address - Phone:281-794-6646
Practice Address - Fax:281-554-2914
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508927367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife