Provider Demographics
NPI:1588259097
Name:MOFFETT, KEVIN MICHAEL (RN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:RN, PMHNP-BC
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Mailing Address - Street 1:517 28 1/2 RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4914
Mailing Address - Country:US
Mailing Address - Phone:303-929-6609
Mailing Address - Fax:
Practice Address - Street 1:517 28 1/2 RD APT 2C
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4914
Practice Address - Country:US
Practice Address - Phone:303-929-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998952-NP363LP0808X
CORN.1638843163WP0808X
CO1638843163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health