Provider Demographics
NPI:1225522121
Name:MOYLE, KATHERYN A
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:A
Last Name:MOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 IRON DR
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-3113
Mailing Address - Country:US
Mailing Address - Phone:775-240-4988
Mailing Address - Fax:
Practice Address - Street 1:2215 IRON DR
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3113
Practice Address - Country:US
Practice Address - Phone:775-240-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician