Provider Demographics
NPI:1114707882
Name:PERNOT-MOYER, KATIE LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:PERNOT-MOYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1430
Mailing Address - Country:US
Mailing Address - Phone:570-479-0877
Mailing Address - Fax:
Practice Address - Street 1:1371 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2840
Practice Address - Country:US
Practice Address - Phone:570-963-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028097363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology