Individual
KATHRYN KOLB MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.N., F.N.P-BC
Contact information
Practice address
1900 WOODLAND DR, UROLOGY, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4574
Mailing address
1900 WOODLAND DR, FAMILY MEDICINE, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4574
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
200442251RN
OR
363LF0000X
Family Nurse Practitioner
Primary
200450152NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NORTH BEND MEDICAL CENTER GROUP NPI
OR
01
—
161133
NORTH BEND MEDICAL CENTER GROUP MEDICAID
OR
05
—
292415
—
OR
01
—
93-0635514
NORTH BEND MEDICAL CENTER GROUP TAX ID
OR
01
—
P01673840
PALMETTO GBA - RAILROAD
OR
01
—
R0000WFBTV
NORTH BEND MEDICAL CENTER GROUP MEDICARE
OR
Enumeration date
07/06/2006
Last updated
08/08/2016
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