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General NPI Number Information
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NPI Number | 1366321937
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Entity Type | Individual
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Provider Name | KATE MOON NP-BC
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Gender |
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2601 LAKESIDE PKWY STE 180
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4291
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Country | US
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Telephone | 972-874-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 BERKELEY AVE
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City | COPPER CANYON
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State | TX
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Zip | 75077-8483
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Country | US
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Telephone | 860-882-7400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1069585
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License Number State | TX
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