1699863142 NPI number — KAREN K MOELLER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699863142 NPI number — KAREN K MOELLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOELLER
Provider First Name:
KAREN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699863142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7625 ASHLEYWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40241-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 FANNIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-824-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085P0229X , with the licence number:  37766 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: T7440 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000544151 . This is a "ANTHEM - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023029Y . This is a "HUMANA - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 91709 . This is a "SIHO - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2442247000 . This is a "PAD - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50016963 . This is a "PASSPORT - KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64064330 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200431700 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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