Provider Demographics
NPI:1972268845
Name:MOORE, JULIA PRICE (PMHNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PRICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MILLER ST SE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3630
Mailing Address - Country:US
Mailing Address - Phone:540-449-2508
Mailing Address - Fax:
Practice Address - Street 1:2774 ELECTRIC RD STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3586
Practice Address - Country:US
Practice Address - Phone:540-344-5300
Practice Address - Fax:540-572-7001
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183062363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty