Provider Demographics
NPI:1700314929
Name:MOORE, KENDALL MARIA
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N ST SW APT 322
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3521
Mailing Address - Country:US
Mailing Address - Phone:202-531-1472
Mailing Address - Fax:
Practice Address - Street 1:203 N ST SW APT 322
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3521
Practice Address - Country:US
Practice Address - Phone:202-531-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid