Individual provider Active NPI

Kathlyen Mora

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1861902702
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308216 Issued in NY
Practice address
408 W 14TH St Ste 201
New York, NY 10014
Phone
(212) 530-0639
Fax
(212) 867-4353
NPI assigned
Oct 5, 2017
Last updated
Aug 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308216 NY Primary

Addresses

Primary practice location

408 W 14TH St Ste 201
New York, NY 10014

Mailing address

129 W 29TH St FL 10
New York, NY 10001-5105
Phone (415) 658-6791

Other practice location 1

2015 Grand Concourse
Bronx, NY 10453-4303
Phone (718) 299-7295

Other practice location 2

2015 Grand Concourse
Bronx, NY 10453-4303
Phone (718) 299-7295

Other practice location 3

632 Broadway Ph
New York, NY 10012-2614
Phone (800) 731-4254

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230817000262 NY Order and Referring Only - Nurse Practitioner 9436415403

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F308216NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai School of Medicine Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1861902702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W 29TH ST FL 10",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015105",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W 14TH ST STE 201",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10014",
            "telephone_number": "212-530-0639",
            "fax_number": "212-867-4353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104534303",
            "country_code": "US",
            "telephone_number": "718-299-7295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2015 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104534303",
            "country_code": "US",
            "telephone_number": "718-299-7295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "632 Broadway Ph",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100122614",
            "country_code": "US",
            "telephone_number": "800-731-4254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORA",
        "first_name": "KATHLYEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.