Provider Demographics
NPI:1356424949
Name:MOORE, KIMBERLIE MICHELE (RDMS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLIE
Middle Name:MICHELE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-2642
Mailing Address - Country:US
Mailing Address - Phone:432-333-5100
Mailing Address - Fax:
Practice Address - Street 1:1418 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-2642
Practice Address - Country:US
Practice Address - Phone:432-333-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350492471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography