Provider Demographics
NPI:1811012412
Name:MORIARTY HOMSY, KERRY MAUREEN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MAUREEN
Last Name:MORIARTY HOMSY
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:MAUREEN
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4002 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4506
Mailing Address - Country:US
Mailing Address - Phone:760-940-7410
Mailing Address - Fax:
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-940-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588041163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health