Healthcare Provider Details

I. General information

NPI: 1396089603
Provider Name (Legal Business Name): KATHLEEN LACY MOEHRING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PRINTERS PKWY
COLORADO SPRINGS CO
80910-3190
US

IV. Provider business mailing address

2427 N CORONA ST
COLORADO SPRINGS CO
80907-7047
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone: 719-964-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0990486
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: