KELLY MOORE NP NPI 1104303072

NPI Information

  • NPI: 1104303072
  • Provider Name: KELLY MOORE, NP
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 703 S AMERICANA BLVD STE 150
    BOISE, ID
    ZIP 83702
  • Phone: (208) 706-6375

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NPI Details

Kelly Moore, NP is a psychiatric/mental health nurse practitioner in Boise, ID with 7 years of experience. Kelly Moore, NP NPI is 1104303072. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

703 S AMERICANA BLVD STE 150
BOISE, ID
ZIP 83702-976
Phone: (208) 706-6375

The NPI 1104303072 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/24/2018 and was last updated on 3/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse Practitioner59308IDAHONo
2363LP0808XNurse PractitionerPsychiatric/Mental Health59308IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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