KEVIN NELSON MOORE (NPI# 1710479753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710479753 |
| Entity Type | Individual |
| Full Name | KEVIN NELSON MOORE |
| Credential | PMHNP-BC |
| Practice Address |
550 S Adams St Bloomington IN 47403 |
| Mailing Address |
550 S Adams St Bloomington IN 47403-2165 |
| Practice Telephone | 8123336324 |
| Practice Fax Number | 8123316700 |
| Mailing Telephone | 8123336324 |
| Mailing Fax Number | 8123316700 |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2019-07-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
71008478A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3414 W Arlington Rd, Bloomington, IN 474041305 | 8122595574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154781060 | Kevin Lee Moore | Internal Medicine | 612 Nw 42nd St, Oklahoma City, OK 73118-7004 | 2016-03-04 |
| 1932516788 | Kevin Duane Moore | Licensed Practical Nurse | 121 Swezey Ln, Middle Island, NY 11953-1547 | 2014-07-14 |
| 1982947164 | Kevin Moore | Counselor | 107 Hill St, Apt. 9, Stoneham, MA 02180-3720 | 2013-04-05 |
| 1891917324 | Kevin P. Moore | Marriage & Family Therapist | 7200 W 13th St N Ste 9, Wichita, KS 67212-2968 | 2007-05-03 |
| 1255484036 | Kevin Brian Moore | Chiropractor | 1004 Butler Ave, New Castle, PA 16101-4282 | 2007-01-18 |
| 1275690323 | Kevin Lee Moore | Dentist | 160 S 2nd Ave, Suite B, Clarion, PA 16214-2444 | 2007-01-01 |
| 1225199706 | Kevin Brent Moore | Dentist | 95 Stonecoal Road, Garrett, KY 41630 | 2006-12-12 |
| 1447319645 | Kevin Moore | Counselor | 314 Maxwell Rd Ste 400, Alpharetta, GA 30004-2045 | 2006-12-06 |
| 1619040037 | Kevin R Moore | Case Manager/Care Coordinator | 10528 Nw 57th Ct, Coral Springs, FL 33076-2810 | 2006-11-15 |
| 1023069176 | Kevin Joel Moore | Chiropractor | 3420 Elmore Ave, Davenport, IA 52807-2594 | 2006-05-13 |
| Street Address |
550 S ADAMS ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023094174 | Bethany Ann Murray | Registered Nurse | 550 S Adams St, Bloomington, IN 47403-2165 | 2005-12-21 |
| 1376176065 | Laura Reece | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2020-02-20 |
| 1518423649 | Sierra L Hofmann | Marriage & Family Therapist | 550 S Adams St, Bloomington, IN 47403-2165 | 2019-02-13 |
| 1730659301 | Grant Thomas Gilliam | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2018-11-27 |
| 1275001554 | Leah D Walden | Social Worker | 550 S Adams St, Bloomington, IN 47403-2165 | 2018-11-05 |
| 1023536216 | Quillian Murphy | Counselor | 550 S Adams St, Bloomington, IN 47403 | 2017-09-07 |
| 1902334659 | Jessica L Cielo | Registered Nurse | 550 S Adams St, Bloomington, IN 47403 | 2017-05-25 |
| 1609225085 | Julie Miller | Social Worker | 550 S Adams St, Bloomington, IN 47403-2165 | 2016-06-07 |
| 1023494333 | Nandita Miriam Rajanayakam | Counselor | 550 S Adams St, Bloomington, IN 47403-2165 | 2015-08-10 |
| 1659629178 | Carmen J Levasseur | Social Worker | 550 S Adams St, Bloomington, IN 47403-2165 | 2012-08-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134780851 | Eric Lyakhovetsky | Nurse Practitioner | 327 W Saidah Rd, Bloomington, IN 47404-8965 | 2019-06-24 |
| 1477822344 | Wenjing Cao | Nurse Practitioner | 108 W. Market, Bloomington, IL 61701 | 2011-12-22 |
| 1679684203 | Colleen S Odonnell | Nurse Practitioner | 1603 W Old Shakopee Rd, Bloomington, MN 55431-3065 | 2006-08-31 |
| 1558970517 | Randy Bargo | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2020-07-27 |
| 1750921870 | Lotus Integrated Care, LLC | Nurse Practitioner | 654 S Walker St, Bloomington, IN 47403-2159 | 2020-01-07 |
| 1033768569 | Amanda Lavender | Nurse Practitioner | 727 W 2nd St, Bloomington, IN 47403-2209 | 2019-09-07 |
| 1396215786 | Hui Shi Serena Loh | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2018-11-28 |
| 1922583285 | Bettina Ervin-rodgers | Nurse Practitioner | 108 W Market St, Bloomington, IL 61701-3918 | 2018-10-02 |
| 1205287513 | Stephanie B. Pemberton | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2016-06-28 |
| 1578942348 | Brandee Kay Marksberry | Nurse Practitioner | 445 S Landmark Ave, Bloomington, IN 47403-5004 | 2015-05-26 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
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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.