Provider Demographics
NPI:1447669072
Name:MOORE, KATHRYN MCCALLUM
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MCCALLUM
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5210
Mailing Address - Country:US
Mailing Address - Phone:907-562-7387
Mailing Address - Fax:907-562-7318
Practice Address - Street 1:3900 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5210
Practice Address - Country:US
Practice Address - Phone:907-562-7387
Practice Address - Fax:907-562-7318
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK712174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian