Doctor Name: | HEATHER MOORE |
NPI Number: | 1508258583 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PMHNP-BC |
License Number: | 0024172398 |
Business Practice Address: | 295 S Pointe Shore Dr #108 Moneta, VA - 241212684 |
Business Phone Number: | 6156040888 |
Business Fax Number: | |
Mailing Address: | Po Box 683, MONETA |
State: | VA |
Postal Code: | 241210683 |
Phone Number: | 6156040888 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2015 |
NPI Last Update Date: | 02/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 0024172398 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |