Basic Information
| Provider Information | |||||||||
| NPI: | 1689715732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE-LAWYER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MS, RD, IBCLC, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154770 | ||||||||
| FaxNumber: | 3034154769 | ||||||||
| Practice Location | |||||||||
| Address1: | 5495 ARAPAHOE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154250 | ||||||||
| FaxNumber: | 3034409629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2007 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.1646745 | CO | N | Nursing Service Providers | Registered Nurse | 133V00000X | RN.1646745 | CO | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.