Individual provider Active NPI

Krista Moore, LICSW

  • Clinical Social Worker
  • Owatonna, MN
National Provider Identifier
1467322768
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21441 Issued in MN
Practice address
2575 Harvest LN
Owatonna, MN 55060-4305
Phone
(507) 446-0431
Fax
(507) 446-8014
NPI assigned
Nov 11, 2025
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 21441 MN Primary

Addresses

Primary practice location

2575 Harvest LN
Owatonna, MN 55060-4305

Mailing address

2575 Harvest LN
Owatonna, MN 55060-4305
Phone (507) 446-0431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251121001500 MN Practitioner - Clinical Social Worker 9436641057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Fernbrook Family Center IncGroup PAC ID 3870872914, 31 clinicians

Practice addresses (Care Compare)

2575 Harvest LN
Owatonna, MN 55060-4305
Phone (507) 446-0431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21441MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fernbrook Family Center, Inc CurrentSince Nov 11, 2025 Accepting new patients
Fernbrook Family Center Past Accepting new patients

Locations

2575 Harvest Ln
Owatonna, MN 55060
Phone 5074460431115

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762819200000",
    "number": "1467322768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 HARVEST LN",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604305",
            "telephone_number": "507-446-0431",
            "fax_number": "507-446-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 HARVEST LN",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604305",
            "telephone_number": "507-446-0431",
            "fax_number": "507-446-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KRISTA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-11-11",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owatonna, MN

Sources for this page

Verify at the official NPI Registry.