Most Relevant Information
Provider Data
| NPI Number: | 1003432618 |
| Provider Name: | KIMBERLY A MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/19/2020 |
| Last Updated: | 06/19/2020 |
Provider Practice Location
215 KWIGUK STREET
EMMONAK
AK
99581
Practice Location Phone/Fax
| Phone: | 9079493500 |
| Fax: | 9079493541 |
Provider Mailing Location
215 KWIGUK STREET
EMMONAK
AK
99581
Provider Mailing Phone/Fax
| Phone: | 9079493500 |
| Fax: | 9079493541 |