Provider Demographics
NPI:1669673596
Name:MOXLEY, KELLY MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:8800 GLACIER HWY
Mailing Address - Street 2:SUITE 218
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8087
Mailing Address - Country:US
Mailing Address - Phone:907-789-0405
Mailing Address - Fax:907-789-2925
Practice Address - Street 1:8800 GLACIER HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8087
Practice Address - Country:US
Practice Address - Phone:907-789-0405
Practice Address - Fax:907-789-2925
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK6398213ES0103X
TX1821213ES0103X
CAE 4753213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6398OtherSTATE LICENSE