KELLY MOORE NP
NPI 1669072112
Nurse Practitioner - Primary Care in Fort Worth, TX

Q: What is Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1669072112. It was assigned to this individual provider in the NPPES registry on October 26, 2020.

Q: What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Moore was last updated on May 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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 October 26, 2020PECOS Enrolled

1401 W PULASKI ST, FORT WORTH, TX 76104(817) 454-8055 Get Directions Write a Review

NPPES record last updated: May 6, 2021. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: May 6, 2021, Apr 9, 2021, Oct 26, 2020 (3 updates tracked since 2020).

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About Kelly Moore Np NPPES

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

KELLY MOORE NP (NPI 1669072112) is an individual primary care provider in Fort Worth, Texas, licensed in Texas (1011153) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1669072112

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameKELLY MOORECredential: NP

Location Address1401 W PULASKI STFort Worth, TX 76104-2717

Mailing AddressPo Box 99213Fort Worth, TX 76199-0213 · (682) 885-1860 · Fax (682) 885-1396

Phone(817) 454-8055

Sole ProprietorNo

Enumeration DateOctober 26, 2020

Last NPPES UpdateMay 6, 20213 updates tracked since enumeration

NPPES CertifiedMay 6, 2021

✔ NPI 1669072112 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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

Taxonomy Code363LP2300X

License✔ Licensed in TX · 1011153

Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X · License 1011153 (TX)

1401 W PULASKI ST, Fort Worth, TX 76104

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Imperial Insurance Companies, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Moore Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.20 typical visit price

range $56.47 – $171.07

Typical copayment $21.80 (range $14.11 – $42.76)

Most-billed visit code 99203

Established Patient

$99.68 typical visit price

range $18.18 – $139.68

Typical copayment $24.92 (range $4.54 – $34.92)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

HINA AZIZ REHMAN MD

Pediatrics