MEDICARE: KAREN AGNES MOULTON FNP MASTER HLTH SVCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	257756	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	671	OTHER	CA	NP FURNISHING # BRN
2	008228322	OTHER		NP CERT # ANCC
3	09224372	OTHER		CDE

General Provider Information

NPI Number	:	1619988227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN AGNES MOULTON FNP MASTER HLTH SVCS

Provider Business Mailing Address
First Line	:	1 HARPST ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-8222
Country	:	US
Telephone Number	:	707-826-5060
Fax Number	:	707-826-5042

Provider Business Practice Location Address
First Line	:	1 HARPST ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-8222
Country	:	US
Telephone Number	:	707-826-5060
Fax Number	:	707-826-5042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	03/07/2023

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