Provider Demographics
NPI:1831842590
Name:MOO, KA
Entity type:Individual
Prefix:
First Name:KA
Middle Name:
Last Name:MOO
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 1:2527 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2249
Mailing Address - Country:US
Mailing Address - Phone:402-669-7213
Mailing Address - Fax:
Practice Address - Street 1:2111 S 67TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2882
Practice Address - Country:US
Practice Address - Phone:402-356-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care