KELLY MOORE (NPI# 1104303072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104303072 |
| Entity Type | Individual |
| Full Name | KELLY MOORE |
| Credential | NP |
| Practice Address |
3280 E Lanark Dr Meridian ID 83642-5982 |
| Mailing Address |
Po Box 191050 Boise ID 83719-1050 |
| Practice Telephone | 2083774400 |
| Practice Fax Number | 2083774416 |
| Mailing Telephone | 2089556500 |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2019-08-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 59308 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 435 S Eagle Rd, Eagle, ID 836166067 | 2089398200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457901233 | Kelly Lynn Moore | Counselor | 11111 E Mississippi Ave Ste 268, Aurora, CO 80012-3106 | 2019-09-13 |
| 1962981563 | Kelly Moore | Massage Therapist | 1776 S Jackson St Ste 830, Denver, CO 80210-3807 | 2018-08-14 |
| 1134619018 | Kelly Michelle Moore | Social Worker | 446 Pinecrest Cir, Long Beach, MS 39560-3639 | 2018-05-16 |
| 1932630902 | Kelly Moore | Optometrist | 1611 Plummer St #112e, North Hills, CA 91403-2036 | 2017-03-22 |
| 1780128942 | Kelly Renee Moore | Nurse Practitioner | 224 Margaret Michelle Ct, Saint Peters, MO 63376-4812 | 2016-12-07 |
| 1568817369 | Kelly Moore | Skilled Nursing Facility | 29 Nonotuck Rd, West Springfield, MA 01089-1616 | 2016-04-28 |
| 1588042980 | Kelly Moore | Registered Nurse | 1507 Broad Blvd, Cuyahoga Falls, OH 44223-2434 | 2015-05-18 |
| 1770977563 | Kelly Moore | Registered Nurse | 1120 Huffman Rd Ste 24-787, Anchorage, AK 99515-3516 | 2015-03-19 |
| 1790106342 | Kelly Ann Moore | Behavioral Analyst | 17845 Ridgeland Ave, Tinley Park, IL 60477-4383 | 2013-12-29 |
| 1720327570 | Kelly Moore | Occupational Therapy Assistant | 1848 E Gemini Dr, Tempe, AZ 85283-6000 | 2013-02-13 |
| Street Address |
3280 E LANARK DR |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-5982 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275584534 | Katie L Weller | Nurse Practitioner | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2006-05-12 |
| 1205398708 | Kelsey Martin | Nurse Practitioner | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2019-04-03 |
| 1316410558 | Kaley A Martinson | Physician Assistant | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2019-01-10 |
| 1184134843 | Erin Marie Shumard | Physician Assistant | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2017-10-09 |
| 1558815670 | Courtney Smith | Physician Assistant | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2016-08-05 |
| 1114056132 | Aaron Jay Epperson | Specialist/Technologist | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2007-03-05 |
| 1932110939 | Margo Smedshammer | Physician Assistant | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2006-08-11 |
| 1265478531 | Susan C Kim | Pediatrics | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2006-06-22 |
| 1942245840 | David L Peterman | Pediatrics | 3280 E Lanark Dr, Meridian, ID 83642-5982 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164043162 | Slavik Osipchuk | Nurse Practitioner | 2329 W Root Creek St, Meridian, ID 83646-4678 | 2020-04-30 |
| 1760025639 | Kimberly Watson | Nurse Practitioner | 3536 W Moon Lake St, Meridian, ID 83646-8304 | 2019-10-23 |
| 1649824277 | Bryana Michel Hinck | Nurse Practitioner | 150 W Broderick Dr, Meridian, ID 83646-0009 | 2019-07-31 |
| 1457846206 | Teri Ann Meadows | Nurse Practitioner | 520 S Eagle Rd Ste 3211, Meridian, ID 83642-6356 | 2018-06-25 |
| 1871017855 | Robbyn Lee | Nurse Practitioner | 4715 24th Place, Meridian, MS 39305 | 2017-08-01 |
| 1326584640 | Kyle Joseph Ronnau | Nurse Practitioner | 1672 S Woodsage Avenue, Suite #120, Meridian, ID 83642 | 2017-01-10 |
| 1720522436 | Jennifer Robinson | Nurse Practitioner | 2985 S Meridian Rd Ste 100, Meridian, ID 83642-8051 | 2016-12-14 |
| 1366733164 | Erica Glover | Nurse Practitioner | 10641 Highway 80 W, Meridian, MS 39307-9256 | 2011-04-27 |
| 1568545556 | Angela Mcdonald | Nurse Practitioner | Nbhc Meridian 1801 Fuller St Bldg 367, Meridian, MS 39309-3107 | 2006-10-23 |
| 1275631244 | Cherese R Tarter | Nurse Practitioner | 1560 N Crestmont Dr Ste A, Meridian, ID 83642-2178 | 2006-09-21 |
| Find all providers in MERIDIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.