Provider Demographics
NPI:1437859311
Name:MOORE, KARSON COLLINS (AUD)
Entity Type:Individual
Prefix:
First Name:KARSON
Middle Name:COLLINS
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KARSON
Other - Middle Name:MACKENZIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4142
Mailing Address - Country:US
Mailing Address - Phone:704-878-6600
Mailing Address - Fax:
Practice Address - Street 1:703 BRYANT ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4142
Practice Address - Country:US
Practice Address - Phone:704-878-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13590231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist