Provider Demographics
NPI:1194483917
Name:MOORE, FRANKIE JOHN
Entity type:Individual
Prefix:
First Name:FRANKIE
Middle Name:JOHN
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-8035
Mailing Address - Country:US
Mailing Address - Phone:434-709-6454
Mailing Address - Fax:434-709-1010
Practice Address - Street 1:15 BOYD ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-2707
Practice Address - Country:US
Practice Address - Phone:434-709-6454
Practice Address - Fax:434-709-1010
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)