Provider Demographics
NPI:1144262379
Name:WESLEY, KIMBERLY MOORE (ANP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MOORE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 COULTER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1122
Mailing Address - Country:US
Mailing Address - Phone:315-462-9478
Mailing Address - Fax:315-462-6707
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:585-922-1900
Practice Address - Fax:585-922-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304185363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health