Provider Demographics
NPI:1336358001
Name:MORIARTY, KAREN J (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 TAFT BLVD APT 4303
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-5394
Mailing Address - Country:US
Mailing Address - Phone:940-923-6959
Mailing Address - Fax:
Practice Address - Street 1:310 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-1600
Practice Address - Country:US
Practice Address - Phone:940-592-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521174363LF0000X
TXAP108160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP108160OtherNURSING LICENSE
1336358001OtherNPI
TX039627701Medicaid
TX039627701Medicaid