Provider Demographics
NPI:1043927452
Name:MOORE, BARBARA LUCILLE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LUCILLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2232
Mailing Address - Country:US
Mailing Address - Phone:681-385-0159
Mailing Address - Fax:
Practice Address - Street 1:961 GORDON DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2232
Practice Address - Country:US
Practice Address - Phone:681-385-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant