Provider Demographics
NPI:1437612496
Name:MOUA, KATTIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATTIE
Middle Name:
Last Name:MOUA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 12TH ST S APT 1916
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4238
Mailing Address - Country:US
Mailing Address - Phone:864-580-1540
Mailing Address - Fax:
Practice Address - Street 1:7401 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3402
Practice Address - Country:US
Practice Address - Phone:301-982-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily