Active NPI
Kayla D Moorer, PHD, LP
- Counseling Psychologist
- Fargo, ND
National Provider Identifier
1992201917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 564
- Practice address
- 1330 Page Dr S Ste 102a
Fargo, ND 58103-3562 - Phone
- (701) 478-6604
- NPI assigned
- Mar 30, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2949 | OR | |
| Health Service Psychologist | 103TH0100X | 2949 | OR | |
| Counseling Psychologist | 103TC1900X | 564 | ND | Primary |
Addresses
Primary practice location
1330 Page Dr S Ste 102a
Fargo, ND 58103-3562
Mailing address
1204 12TH St S
Moorhead, MN 56560-3708
Phone (601) 580-5453
Other practice location 1
677 E 12th Ave Ste 400
Eugene, OR 97401-3611
Phone (541) 346-3227
Other practice location 2
132 E Broadway Ste 301
Eugene, OR 97401
Phone (541) 852-8862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1476477 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 564 | ND | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554940800000",
"number": "1992201917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1204 12TH ST S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565603708",
"telephone_number": "601-580-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 PAGE DR S STE 102A",
"city": "FARGO",
"state": "ND",
"postal_code": "581033562",
"telephone_number": "701-478-6604"
}
],
"practiceLocations": [
{
"address_1": "677 E 12th Ave Ste 400",
"address_purpose": "LOCATION",
"city": "Eugene",
"state": "OR",
"postal_code": "974013611",
"country_code": "US",
"telephone_number": "541-346-3227",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "132 E Broadway Ste 301",
"address_purpose": "LOCATION",
"city": "Eugene",
"state": "OR",
"postal_code": "97401",
"country_code": "US",
"telephone_number": "541-852-8862",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORER",
"first_name": "KAYLA",
"middle_name": "D",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-30",
"last_updated": "2019-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "2949",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "OR",
"license": "2949",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "ND",
"license": "564",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1476477",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.