Provider Demographics
NPI:1457954034
Name:MOYERS, DENISE SUSAN (RN, CCM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SUSAN
Last Name:MOYERS
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HUEBNER ROAD
Mailing Address - Street 2:DEPT OF BEHAVIORAL HEALTH (CAFBHS)
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-240-7491
Mailing Address - Fax:785-240-8357
Practice Address - Street 1:650 HUEBNER ROAD
Practice Address - Street 2:DEPT OF BEHAVIORAL HEALTH (CAFBHS)
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-240-7491
Practice Address - Fax:785-240-8357
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-78704-22163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management