# L KATHERINE MOON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** L KATHERINE MOON
- **Other names:** Fishers Landing Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275295164
- **Legal business name:** L KATHERINE MOON
- **Authorized official:** L KATHERINE MOON FNP (OWNER)
- **Authorized official phone:** (360) 816-0277

## Contact information

- **Practice address:** 406 SE 131ST AVE STE C, VANCOUVER, WA 98683-4004
- **Practice address phone:** (360) 816-0277
- **Practice address fax:** (360) 567-4004
- **Mailing address:** 6715 NE 63RD ST STE 436, VANCOUVER, WA 98661-1980
- **Mailing address phone:** (360) 816-0277
- **Mailing address fax:** (360) 567-4004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/08/2021
- **Last updated:** 02/06/2022