Provider Demographics
NPI:1689715732
Name:MOORE-LAWYER, KELLY C (MS, RD, IBCLC, BSN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:MOORE-LAWYER
Suffix:
Gender:F
Credentials:MS, RD, IBCLC, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4770
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:5495 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1224
Practice Address - Country:US
Practice Address - Phone:303-415-4250
Practice Address - Fax:303-440-9629
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1646745163W00000X, 133V00000X, 163W00000X
CA707358163W00000X
WA00174800163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant