Provider Demographics
NPI:1154296408
Name:MORE WELLNESS MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:MORE WELLNESS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:757-724-7310
Mailing Address - Street 1:4019 COBBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-4518
Mailing Address - Country:US
Mailing Address - Phone:757-724-7310
Mailing Address - Fax:757-724-7310
Practice Address - Street 1:4019 COBBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DISPUTANTA
Practice Address - State:VA
Practice Address - Zip Code:23842-4518
Practice Address - Country:US
Practice Address - Phone:757-724-7310
Practice Address - Fax:757-724-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty