Provider Demographics
NPI:1568603975
Name:MOFFETT, KARINA ISELA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KARINA
Middle Name:ISELA
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KARINA
Other - Middle Name:ISELA
Other - Last Name:REYNOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 N PEPPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-1429
Mailing Address - Country:US
Mailing Address - Phone:559-805-8527
Mailing Address - Fax:
Practice Address - Street 1:590 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-805-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016201363LP0200X
CA743106163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics