Kathleen T Moffitt, CERTIFIED NURSE MIDW

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0024073304 Issued in VA

Practice address

11730 Sudley Manor Drive
Manassas, VA 20109-2843

Phone

(703) 257-3001

Fax

(703) 257-3133

NPI assigned

Dec 27, 2006

Last updated

May 16, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  dba Kaiser Permanente Shady Grove Peritoneal Dialysis Facility

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1831254093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 24TH ST",
            "address_2": "KENNER CLINIC AT FORT LEE",
            "city": "FORT LEE",
            "state": "VA",
            "postal_code": "238011716",
            "telephone_number": "804-734-9942",
            "fax_number": "877-874-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11730 SUDLEY MANOR DRIVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092843",
            "telephone_number": "703-257-3001",
            "fax_number": "703-257-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFITT",
        "first_name": "KATHLEEN",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "CERTIFIED NURSE MIDW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024073304",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0001073304",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Gregory Mittelman
• Mizener & Associates Physical Therapy (David S Mizener PT)
• David S Mizener, P.T.
• Mobile Orthopaedics & Rehabilitation, PT
• Renee Moffett
• Healther M. Mogg
• Mohammed H. Azim M.D. and Ahmad Z. Qasimyar M.D. PC
• Suhier Mohammed
• Elizabeth Joy Mohaupt, MA, LPC, NCC
• Dana Mohl, FNP

• Nurse Practitioner in Manassas, VA
• Providers in Manassas, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.