Provider Demographics
NPI:1053057208
Name:MOORE, JUANITA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5016
Mailing Address - Country:US
Mailing Address - Phone:865-453-1032
Mailing Address - Fax:865-453-7271
Practice Address - Street 1:719 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5016
Practice Address - Country:US
Practice Address - Phone:865-453-1032
Practice Address - Fax:865-453-7271
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN256897163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health