| Doctor Name: | MS. KERRY E MOORE |
| NPI Number: | 1194027243 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 336292 |
| Business Practice Address: | 350 New Campus Dr Suny College At Brockport Hazen Health Center Brockport, NY - 144202997 |
| Business Phone Number: | 5853952414 |
| Business Fax Number: | 5853952559 |
| Mailing Address: | 350 New Campus Dr, Suny College At Brockport Hazen Health Center BROCKPORT |
| State: | NY |
| Postal Code: | 144202997 |
| Phone Number: | 5853952414 |
| Fax Number: | 5853952559 |
| NPI Enumeration Date: | 11/23/2010 |
| NPI Last Update Date: | 06/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 336292 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |