Provider Demographics
NPI:1134231400
Name:MOORE, KIMBERLI KAYE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:KAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 TELECOM DR STE I
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3496
Mailing Address - Country:US
Mailing Address - Phone:731-793-2266
Mailing Address - Fax:731-291-1131
Practice Address - Street 1:5120 TELECOM DR STE I
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3496
Practice Address - Country:US
Practice Address - Phone:731-793-2266
Practice Address - Fax:731-291-1131
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist