Provider Demographics
NPI:1881802916
Name:MOYER, KIMBERLEE ADELE (RN,MSN,CS)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ADELE
Last Name:MOYER
Suffix:
Gender:F
Credentials:RN,MSN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-0584
Mailing Address - Country:US
Mailing Address - Phone:802-483-2095
Mailing Address - Fax:
Practice Address - Street 1:65 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3252
Practice Address - Country:US
Practice Address - Phone:802-773-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0017331163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5908Medicare UPIN