MISS KELLEY NICOLE MOORE (NPI# 1417313784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417313784 |
| Entity Type | Individual |
| Full Name | MISS KELLEY NICOLE MOORE |
| Credential | PHARMD |
| Practice Address |
3745 Louisiana Ave S St Louis Park MN 55426-4361 |
| Practice Telephone | 9529260170 |
| Practice Fax Number | 9529261125 |
| Mailing Telephone | 9529260170 |
| Mailing Fax Number | 9529261125 |
| Enumeration Date | 2016-01-02 |
| Last Update Date | 2016-01-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 121059 | MN | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598958647 | Kelley Newman Moore | Dentist | 1 Orange Ave, Rockledge, FL 32955-2945 | 2007-08-22 |
| 1740326289 | Kelley K. Moore | Psychiatry & Neurology | 4851 Independence St., 70 Executive Center, Wheat Ridge, CO 80033-6715 | 2007-01-30 |
| 1871084335 | Kelley Moore | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103-3324 | 2018-05-21 |
| 1679823538 | Kelley Michelle Moore | Case Manager/Care Coordinator | 1911 Williams Dr, Oxnard, CA 93036-2612 | 2012-09-18 |
| 1205026531 | Kelley Rene Moore | Case Manager/Care Coordinator | 4425 Jefferson Ave, Suite 106, Texarkana, AR 71854-1535 | 2007-08-01 |
| 1639165343 | Kelley C Moore | Nurse Anesthetist, Certified Registered | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2005-09-27 |
| Street Address |
3745 LOUISIANA AVE S |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426-4361 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912286584 | Ai Soundara | Optometrist | 3745 Louisiana Ave S, St Louis Park, MN 55426-4361 | 2011-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861003386 | Joshua Limberg | Pharmacist | 7445 Oak Park Village Dr Apt 3, St Louis Park, MN 55426-4143 | 2020-08-10 |
| 1871976647 | Matthew Rodstein | Pharmacist | 2964 Virginia Ave S, St Louis Park, MN 55426-3036 | 2015-06-29 |
| 1154694982 | Clyde Stephens IIi | Pharmacist | 1155 Ford Rd, St Louis Park, MN 55426-1099 | 2012-02-09 |
| 1629357413 | Jill Marie Olson | Pharmacist | 4125 Raleigh Ave, St Louis Park, MN 55416-3247 | 2011-08-10 |
| 1447546635 | Jessica Lynn Gerhartz | Pharmacist | 4124 Toledo Ave S, St Louis Park, MN 55416-3207 | 2011-06-26 |
| 1811051832 | Joyce K Lee | Pharmacist | 4401 Park Glen Rd, Apt 125, St Louis Park, MN 55416-4700 | 2006-12-21 |
| 1619981818 | Jennifer Riss | Pharmacist | 3620 Texas Ave S, St Louis Park, MN 55426-4039 | 2006-07-27 |
| 1336126325 | Sarah Elizabeth Groen | Pharmacist | 5100 Gamble Dr Ste 100, St Louis Park, MN 55416-1588 | 2005-12-29 |
| 1447236682 | Steve E Pauli | Pharmacist | 3777 Park Center Blvd, St Louis Park, MN 55416-2515 | 2005-12-20 |
| 1093712390 | Molly Jo Ekstrand | Pharmacist | 6600 Excelsior Blvd Ste 151, St Louis Park, MN 55426-4706 | 2005-06-30 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
Please comment or provide details below to improve the information on MISS KELLEY NICOLE MOORE.
| 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.