Provider Demographics
NPI:1902250764
Name:MORI, KATHRYN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MORI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 SKIDAWAY RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-6446
Mailing Address - Country:US
Mailing Address - Phone:912-233-6811
Mailing Address - Fax:912-544-0864
Practice Address - Street 1:7450 SKIDAWAY RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-6446
Practice Address - Country:US
Practice Address - Phone:912-233-6811
Practice Address - Fax:912-544-0864
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily