Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Moore, NP

Individual provider Nurse Practitioner · NPI 1104303072

Kelly Moore, NP is a Nurse Practitioner in Boise, Idaho. Qualified in 2018, 8 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
8
Licensed in
ID
In the registry since
2018
Specialties on file
2
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

703 S Americana Blvd Ste 150
Boise, ID 83702-4976
Phone: (208) 706-6375
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3280 E Lanark Dr, Meridian, ID 83642-5982 — (208) 377-4400

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 59308 (ID)
Nurse Practitioner Taxonomy 363L00000X · Licence 59308 (ID)

Record details

NPI number1104303072
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorYes
NPI enumeratedJuly 24, 2018
Last updated in NPPESMarch 21, 2023
Certification dateMarch 21, 2023
Mailing address190 E Bannock St, Boise, ID 83712-6241

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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