MEDICARE: KATHRYN NICOLE MORAN AGPCNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	AP141302	TX

General Provider Information

NPI Number	:	1700348836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN NICOLE MORAN AGPCNP-BC

Provider Business Mailing Address
First Line	:	6723 DELOACHE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-2510
Country	:	US
Telephone Number	:	314-814-0452
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 GASTON AVE STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2037
Country	:	US
Telephone Number	:	469-800-9000
Fax Number	:

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

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	01/06/2023

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