Provider Demographics
NPI:1982015491
Name:MOORE, KIERA L (AUD)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8258
Mailing Address - Country:US
Mailing Address - Phone:575-680-2434
Mailing Address - Fax:855-780-8990
Practice Address - Street 1:4351 E LOHMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8258
Practice Address - Country:US
Practice Address - Phone:575-680-2434
Practice Address - Fax:855-780-8990
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO721237600000X
NMSAH-2023-0111231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter