Provider Demographics
NPI:1770999674
Name:MOORE, KATHY (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 K ST NW #606 AIDS HEALTHCARE FOUNDATION (AHF)
Mailing Address - Street 2:BLAIR UNDERWOOD HEALTHCARE CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-293-8680
Mailing Address - Fax:
Practice Address - Street 1:2141 K ST NW #606 AIDS HEALTHCARE FOUNDATION (AHF)
Practice Address - Street 2:BLAIR UNDERWOOD HEALTHCARE CENTER C/O DR ROXANNE COX
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-293-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant