Doctor Name: | MS. VERNITA S MOORE |
NPI Number: | 1093050734 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | RN127868 |
Business Practice Address: | 907 18th St E Suite 260 Tifton, GA - 317943643 |
Business Phone Number: | 2293913680 |
Business Fax Number: | |
Mailing Address: | 907 18th St E, Suite 150 TIFTON |
State: | GA |
Postal Code: | 317943643 |
Phone Number: | 2293533422 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2012 |
NPI Last Update Date: | 03/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN127868 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |