Provider Demographics
NPI:1720569593
Name:MOORE, COLLEEN MARIE-KIESER (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE-KIESER
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6806
Mailing Address - Country:US
Mailing Address - Phone:509-993-8585
Mailing Address - Fax:
Practice Address - Street 1:1520 W 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7040
Practice Address - Country:US
Practice Address - Phone:509-747-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60919281363LP0808X, 363L00000X, 363LG0600X, 363LP2300X, 363L00000X
OR202208557NP-PP363L00000X
WAAP60158260363LA2200X
MTNUR-APRN-LIC-132035363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care