Provider Demographics
NPI:1972078046
Name:MOORE, KATHERINE ROYA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROYA
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ROYA
Other - Last Name:MOINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2405 NE 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-9793
Mailing Address - Country:US
Mailing Address - Phone:580-695-7374
Mailing Address - Fax:
Practice Address - Street 1:415 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3710
Practice Address - Country:US
Practice Address - Phone:580-695-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily