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General NPI Number Information
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NPI Number | 1881165215
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Entity Type | Individual
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Provider Name | KATHRYN ELIZABETH MORA PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 915 OLENTANGY RIVER RD STE 3200
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City | COLUMBUS
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State | OH
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Zip | 43212-3167
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Country | US
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Telephone | 614-293-2663
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Fax | 614-293-2053
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Provider Business Mailing Address
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Address Line | 700 ACKERMAN RD STE 2120
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City | COLUMBUS
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State | OH
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Zip | 43202-1559
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Country | US
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Telephone | 614-293-2663
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Fax | 614-293-2053
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50.005736RX
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License Number State | OH
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