| NPI | 1548156912 |
|---|---|
| Former Name | KELLY ELIZABETH MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95035386) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95035386) |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-09-15 |