Provider Demographics
NPI:1366321937
Name:MOON, KATE (NP-BC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MOON
Suffix:
Gender:X
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:COPPER CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8483
Mailing Address - Country:US
Mailing Address - Phone:860-882-7400
Mailing Address - Fax:
Practice Address - Street 1:2601 LAKESIDE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4291
Practice Address - Country:US
Practice Address - Phone:972-874-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine