| Doctor Name: | MRS. TARA THOMPSON MOORE |
| NPI Number: | 1063714046 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RN164184 |
| Business Practice Address: | 426 Ga Highway 26 E Cochran, GA - 310142837 |
| Business Phone Number: | 4789342874 |
| Business Fax Number: | 4789342876 |
| Mailing Address: | 426 Ga Highway 26 E, COCHRAN |
| State: | GA |
| Postal Code: | 310142837 |
| Phone Number: | 4789342874 |
| Fax Number: | 4789342876 |
| NPI Enumeration Date: | 11/24/2010 |
| NPI Last Update Date: | 11/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN164184 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |