Provider Demographics
NPI:1215521398
Name:MOORE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
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 8
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:WV
Mailing Address - Zip Code:25674-0008
Mailing Address - Country:US
Mailing Address - Phone:606-525-5418
Mailing Address - Fax:
Practice Address - Street 1:1412 LEFT MARROWBONE CREEK RD
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:WV
Practice Address - Zip Code:25674-7216
Practice Address - Country:US
Practice Address - Phone:304-393-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker