| Doctor Name: | MRS. LACY MOORE |
| NPI Number: | 1457682874 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 14708 |
| Business Practice Address: | 507 Blackman Blvd W Wartrace, TN - 371832210 |
| Business Phone Number: | 9313890600 |
| Business Fax Number: | |
| Mailing Address: | 507 Blackman Blvd W, WARTRACE |
| State: | TN |
| Postal Code: | 371832210 |
| Phone Number: | 9313890600 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2010 |
| NPI Last Update Date: | 09/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 14708 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |