Doctor Name: | PHYLLIS P MOORE |
NPI Number: | 1023374279 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DNP,FNP-BC |
License Number: | APN0000016606 |
Business Practice Address: | 600 Main St Friendship, TN - 380341999 |
Business Phone Number: | 7316171883 |
Business Fax Number: | 7316773402 |
Mailing Address: | 2086 Arlan Reason Rd, BELLS |
State: | TN |
Postal Code: | 380063865 |
Phone Number: | 7316171883 |
Fax Number: | 7316773402 |
NPI Enumeration Date: | 04/02/2012 |
NPI Last Update Date: | 05/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN0000016606 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |