DR. KATHRYN ROSE MOORE (NPI# 1689850794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689850794 |
| Entity Type | Individual |
| Full Name | DR. KATHRYN ROSE MOORE |
| Other Name | DR. KATHRYN ROSE SHELL |
| Credential | MD |
| Practice Address |
3931 Louisiana Ave S St Louis Park MN 55426-5000 |
| Practice Telephone | 9529932750 |
| Mailing Telephone | 9529932750 |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2014-01-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 125050108 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
MD154557 | OR | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699307538 | Kathryn Moore | Student in an Organized Health Care Education/Training Program | 8307 Knotty Pine Ln, Fairfax Station, VA 22039-3226 | 2020-02-09 |
| 1811495500 | Kathryn Grage Moore | Speech-Language Pathologist | 3200 Pointe Pkwy Ste 200, Peachtree Corners, GA 30092-3370 | 2018-01-27 |
| 1215315569 | Kathryn Pax Lattimore Moore | Psychiatry & Neurology | Uf Health Center for Movement Disorder and Restoration, 3450 Hull Rd, Gainesville, FL 32607 | 2015-05-07 |
| 1477989630 | Kathryn Mccarter Moore | Social Worker | 2520 Robinhood St, #1007, Houston, TX 77005-2547 | 2013-09-19 |
| 1750697371 | Kathryn Adams Moore | Occupational Therapist | 2856 San Benito Dr, Walnut Creek, CA 94598-4105 | 2010-08-19 |
| 1841424652 | Kathryn Anne Moore | Massage Therapist | 404 E 26th St, Suite 105, Tacoma, WA 98421-1312 | 2009-05-07 |
| 1003056326 | Kathryn Moore | Occupational Therapist | 282 Widgedon Lndg, Hilton, NY 14468-8942 | 2009-02-26 |
| 1336389980 | Kathryn Marie Moore | Nurse Practitioner | 2349 Crestcliff Dr, Tucker, GA 30084-4206 | 2009-02-23 |
| 1255577730 | Kathryn Celeste Moore | Durable Medical Equipment & Medical Supplies | 602 Sw 17th St, Seminole, TX 79360-4518 | 2009-01-05 |
| 1346302643 | Kathryn Griffith Moore | Art Therapist | 13652 Adams Springs Rd, Cobb, CA 95426-1096 | 2006-12-14 |
| Street Address |
3931 LOUISIANA AVE S |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265422927 | Anthony G Bottini | Neurological Surgery | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2005-10-25 |
| 1437797917 | Allison Marie White | Dietitian, Registered | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-12-16 |
| 1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
| 1952960841 | Melissa Ann Moran | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-06-13 |
| 1205394004 | Maria Kelley Kearney | Occupational Therapist | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-03-11 |
| 1043790553 | Jack William Bergman | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-08-15 |
| 1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
| 1184147514 | Avri Ann Bock | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-07-18 |
| 1871013037 | Lorraine Marie Richards | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-06-20 |
| 1336672930 | Naoko Onizuka | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134135106 | Kendra L. Kubiak | Internal Medicine | 3931 Louisiana Avenue, St Louis Park, MN 55426 | 2006-07-31 |
| 1285611673 | Amy B Spomer | Internal Medicine | 6490 Excelsior Blvd Ste W01, Park Nicollet Clinic - Mead, St Louis Park, MN 55426 | 2005-12-27 |
| 1962845172 | Michael Benjamin Blazar | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426 | 2013-04-08 |
| 1598025314 | Jayanthi Vijayakumar | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2012-05-26 |
| 1124311048 | Karen Elizabeth Rabenau | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2011-05-25 |
| 1952310237 | Brenda R Larson | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2006-08-05 |
| 1720038748 | Lorre Ann Ochs | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-4375 | 2006-05-11 |
| 1710949920 | Daniel M Anderson | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2006-04-04 |
| 1457338378 | Mark Wilkowske | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-4375 | 2005-12-30 |
| 1760469928 | Mark Menge | Internal Medicine | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2005-12-29 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.