Provider Demographics
NPI:1316783574
Name:MOORE, JUSTIN TYLER (NRP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TYLER
Last Name:MOORE
Suffix:
Gender:M
Credentials:NRP
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 335
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-0335
Mailing Address - Country:US
Mailing Address - Phone:828-220-4174
Mailing Address - Fax:
Practice Address - Street 1:127 E TRADE ST STE B100
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2201
Practice Address - Country:US
Practice Address - Phone:828-220-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP016291146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic