Provider Demographics
NPI:1073958971
Name:MOOCK, KATHY GRAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:GRAY
Last Name:MOOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 MAIN RD
Mailing Address - Street 2:ST JOHN'S HIGH SCHOOL
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3437
Mailing Address - Country:US
Mailing Address - Phone:843-559-6400
Mailing Address - Fax:843-559-6207
Practice Address - Street 1:1518 MAIN RD
Practice Address - Street 2:ST JOHN'S HIGH SCHOOL
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-3437
Practice Address - Country:US
Practice Address - Phone:843-559-6400
Practice Address - Fax:843-559-6207
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24570163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool