Kenneth Jerald Moore | Tulsa, OK • PECOS Search

Kenneth Jerald Moore

Social Worker

Behavioral Health & Social Service Providers

6906 S Utica Pl, Tulsa, OK 74136-5158

PECOS Enrollment

Based on the most recent information from CMS, provider Kenneth Jerald Moore does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1376722348
Provider Type
Individual
Full Name
Moore, Kenneth Jerald
Title
Dr.
Credential
PHD LCSW

Gender
Male
Sole Proprietor
Yes
Enumeration Date
10/26/2007
Last Updated
8/14/2009

Contact Information

Practice Location

6906 S Utica Pl, Tulsa, OK 74136-5158

Unlisted Fax

Mailing Location

6906 S Utica Pl, Tulsa, OK 74136-5158

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 2165 Oklahoma