Provider Demographics
NPI:1285467613
Name:MOYER, KIMBERLEY TATUM (WHNP IBCLC)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:TATUM
Last Name:MOYER
Suffix:
Gender:F
Credentials:WHNP IBCLC
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANNE
Other - Last Name:TATUM-MOYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WHNP IBCLC
Mailing Address - Street 1:214 BLUEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7002
Mailing Address - Country:US
Mailing Address - Phone:970-986-9801
Mailing Address - Fax:
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2089
Practice Address - Country:US
Practice Address - Phone:808-932-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4777-0363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health