Healthcare Provider Details

I. General information

NPI: 1679945406
Provider Name (Legal Business Name): KATHLEEN ELIZABETH MOORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 E US 64 ALT
MURPHY NC
28906-6843
US

IV. Provider business mailing address

567 MOUNT HERMAN RD
MINERAL BLUFF GA
30559-2653
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-8161
  • Fax:
Mailing address:
  • Phone: 828-361-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0815864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: