Provider Demographics
NPI:1619537115
Name:MOORE, KISHA CHANETTE
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:CHANETTE
Last Name:MOORE
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 1:152 QUIET RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5621
Mailing Address - Country:US
Mailing Address - Phone:609-915-6387
Mailing Address - Fax:
Practice Address - Street 1:152 QUIET RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5621
Practice Address - Country:US
Practice Address - Phone:609-915-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker