| Doctor Name: | MS. MARY SUE MOORE |
| NPI Number: | 1508221284 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP9162481 |
| Business Practice Address: | 20370 Ne Burns Ave Blountstown, FL - 324241045 |
| Business Phone Number: | 8506745411 |
| Business Fax Number: | |
| Mailing Address: | 11523 Sw Mcclellan Farm Rd, CLARKSVILLE |
| State: | FL |
| Postal Code: | 324303043 |
| Phone Number: | 8508993191 |
| Fax Number: | |
| NPI Enumeration Date: | 12/22/2015 |
| NPI Last Update Date: | 12/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP9162481 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |