Provider Demographics
NPI:1871212928
Name:MOELLER, KENDALL (DNP, FNP-C, BSN, RN)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:DNP, FNP-C, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 E CAPE HORN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8488
Mailing Address - Country:US
Mailing Address - Phone:520-307-2012
Mailing Address - Fax:
Practice Address - Street 1:2732 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1804
Practice Address - Country:US
Practice Address - Phone:520-382-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95260559163W00000X
MARN2353354163W00000X
WARN60856061163W00000X
AZ219778163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse