Provider Demographics
NPI:1598337180
Name:MOORE, KATHARINE JEANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:JEANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:JEANNE
Other - Last Name:BONNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12421 TOWNER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3659
Mailing Address - Country:US
Mailing Address - Phone:603-620-0008
Mailing Address - Fax:
Practice Address - Street 1:8100 CONSTITUTION PL NE STE 400
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7644
Practice Address - Country:US
Practice Address - Phone:505-559-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily