Provider Demographics
NPI:1649689639
Name:MOORE, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 HALE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1856
Mailing Address - Country:US
Mailing Address - Phone:440-934-8810
Mailing Address - Fax:440-934-8811
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-617-1823
Practice Address - Fax:440-617-0884
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16056-NP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology