Dr. Kevin Thomas Moore, DNP, MSN, RN
Registered Nurse, Administrator in New York, NY. Individual provider (NPI-1).
NPI number1104697127
StatusActive
Last updated in NPPESJan 9, 2024
Details
- NPI
- 1104697127
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kevin Thomas Moore
- Credential
- DNP, MSN, RN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 9, 2024
- Certification date
- Jan 9, 2024
- Last updated
- Jan 9, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WA2000X | Registered Nurse, Administrator | 685106-01 | NY | Yes |
Practice location
1 Park Ave Ofc 3-361New York, NY 10016-5802
Phone 347-802-6895
Mailing address
1 Park Ave Ofc 3-361New York, NY 10016-5802
Phone 347-802-6895
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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