Provider Demographics
NPI:1730448069
Name:MORA, KENDALL KIRBY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:KIRBY
Last Name:MORA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 POINTE WEST WAY
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-2444
Mailing Address - Country:US
Mailing Address - Phone:772-569-2708
Mailing Address - Fax:
Practice Address - Street 1:1055 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6551
Practice Address - Country:US
Practice Address - Phone:772-257-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9249484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily