Provider Demographics
NPI:1841900164
Name:MOORE, NIGEL A
Entity type:Individual
Prefix:
First Name:NIGEL
Middle Name:A
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 1:400 N WALKER AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1896
Mailing Address - Country:US
Mailing Address - Phone:405-943-3700
Mailing Address - Fax:
Practice Address - Street 1:400 N WALKER AVE STE 190
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1896
Practice Address - Country:US
Practice Address - Phone:405-943-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherCASE MANAGEMENT