Provider Demographics
NPI:1326432287
Name:MOORE, LEE (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HICKMAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3572
Mailing Address - Country:US
Mailing Address - Phone:804-767-5703
Mailing Address - Fax:
Practice Address - Street 1:302 HICKMAN RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3572
Practice Address - Country:US
Practice Address - Phone:804-767-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001301606163W00000X
VA0024181190363LP0808X
WAAP60598248363LP0808X
AZAP9661363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse