Provider Demographics
NPI:1518992494
Name:MOON, L KATHERINE (ARNP, FNP,MSN)
Entity Type:Individual
Prefix:
First Name:L KATHERINE
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP, FNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 NE 63RD ST STE 436
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:360-816-0277
Mailing Address - Fax:360-567-4004
Practice Address - Street 1:406 SE 131ST AVE STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-816-0277
Practice Address - Fax:360-567-4004
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS93328Medicare UPIN