Provider Demographics
NPI:1003442419
Name:MOORE, MELINDA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6332 SUMMERWOOD DR E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5005
Mailing Address - Country:US
Mailing Address - Phone:253-228-9674
Mailing Address - Fax:
Practice Address - Street 1:6332 SUMMERWOOD DR E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5005
Practice Address - Country:US
Practice Address - Phone:253-228-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61041911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner