| Doctor Name: | MARY KATE MOORE |
| NPI Number: | 1457793382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, FNP-BC |
| License Number: | 17793 |
| Business Practice Address: | 2707 Jacksboro Pike Suite 1a Jacksboro, TN - 377572752 |
| Business Phone Number: | 4239078186 |
| Business Fax Number: | 4239078187 |
| Mailing Address: | 1409 Bruce Gap Rd, CARYVILLE |
| State: | TN |
| Postal Code: | 377143832 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2013 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 17793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |