Provider Demographics
NPI:1205922192
Name:MOORE, KAREN S (APRN, BC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 HARBOR MILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2654
Mailing Address - Country:US
Mailing Address - Phone:636-225-2092
Mailing Address - Fax:314-993-2065
Practice Address - Street 1:11501 PAGE SERVICE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3530
Practice Address - Country:US
Practice Address - Phone:314-993-3014
Practice Address - Fax:314-993-2065
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN139842363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health