Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 19570 | WV |
Y | 2080P0208X | Pediatric Infectious Diseases | 19570 | WV |
NPI | 1023132750 |
---|---|
Provider Name | Dr. Kathryn S Moffett |
First Address | Morgantown, WV 26507-0897 |
Second Address | Morgantown, WV 26506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 31/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0111774000 | (05) | WV |
F15612 | (02) |