Provider Demographics
NPI:1316922149
Name:MOORE, KAREN M (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PILGRIM HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6130
Mailing Address - Country:US
Mailing Address - Phone:508-737-7033
Mailing Address - Fax:
Practice Address - Street 1:8 PILGRIM HILL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6130
Practice Address - Country:US
Practice Address - Phone:508-747-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP87305Medicare UPIN
MANP4151Medicare ID - Type Unspecified