Provider Demographics
NPI:1407248255
Name:MOORE, KAREN GREEN (WHNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GREEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3548
Mailing Address - Country:US
Mailing Address - Phone:713-831-6554
Mailing Address - Fax:713-535-2554
Practice Address - Street 1:4018 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2749
Practice Address - Country:US
Practice Address - Phone:504-897-9200
Practice Address - Fax:404-494-7433
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08227363LW0102X
LARN062095163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2402439Medicaid