Individual
MRS. KATHLEEN D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Mailing address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN042413-2796
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1541834
—
LA
Enumeration date
02/06/2007
Last updated
02/29/2008
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