KELLY MARIE MOORE FNP-BC
NPI 1649049305
Nurse Practitioner - Family in San Bernardino, CA

Q: What is Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1649049305. It was assigned to this individual provider in the NPPES registry on December 22, 2023. The provider is also known as Kelly Marie Smith.

Q: What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Moore was last updated on February 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 22, 2023

625 CARNEGIE DR STE 120, SAN BERNARDINO, CA 92408(909) 383-2800(909) 880-0439 Get Directions Write a Review

NPPES record last updated: February 14, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kelly Marie Moore Fnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY MARIE MOORE FNP-BC (NPI 1649049305) is an individual family provider in San Bernardino, California, licensed in California (95028281) and active in the NPI registry since December 2023. She maintains a secondary practice location in Encino.

NPPES Registry Identity

NPI1649049305

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY MARIE MOORECredential: FNP-BC

Location Address625 CARNEGIE DR STE 120San Bernardino, CA 92408-3577

Mailing Address11542 Cornell AveRiverside, CA 92507-6613 · (951) 990-2381

Phone(909) 383-2800

Fax(909) 880-0439

Sole ProprietorNo

Enumeration DateDecember 22, 2023

Last NPPES UpdateFebruary 14, 2026

NPPES CertifiedFebruary 14, 2026

✔ NPI 1649049305 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95028281

625 CARNEGIE DR STE 120, San Bernardino, CA 92408

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Other Names 1

Former Name (1)Kelly Marie Smith

Secondary Practice Location 1

Location 15120 Woodley AveEncino, CA 91436-1443 · Phone (628) 432-7476 · Fax (888) 385-7037

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ADEBIMPE ELIZABETH OTEGBOLA NP

Nurse Practitioner (Family)

625 CARNEGIE DR STE 120
SAN BERNARDINO, CA 92408

San Bernardino County (909) 383-2800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1649049305. It was assigned to this individual provider in the NPPES registry on December 22, 2023. The provider is also known as Kelly Marie Smith.

Where is Kelly Moore located?

Kelly Moore practices at 625 Carnegie Dr Ste 120, San Bernardino, CA 92408. The listed phone number is (909) 383-2800.

What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Kelly Moore was last updated on February 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.