Active NPI
Kathryn Moore, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- New York, NY
National Provider Identifier
1912726134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 405945
- Practice address
- 102 Rivers Edge Rd
New York, NY 10035-1163 - Phone
- (646) 766-4979
- NPI assigned
- Oct 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 405945 | NY | Primary |
Addresses
Primary practice location
102 Rivers Edge Rd
New York, NY 10035-1163
Mailing address
102 Rivers Edge Rd
New York, NY 10035-1163
Phone (646) 766-4979
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250226001602 | NY | Order and Referring Only - Nurse Practitioner | 6204356884 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 405945 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753228800000",
"number": "1912726134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 RIVERS EDGE RD",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100351163",
"telephone_number": "646-766-4979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 RIVERS EDGE RD",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100351163",
"telephone_number": "646-766-4979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KATHRYN",
"credential": "PMHNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-04",
"last_updated": "2025-07-23",
"certification_date": "2025-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NY",
"license": "405945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.