Provider Demographics
NPI:1073296257
Name:MOORE, RAVEN ORGERON (MSN, RN)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:ORGERON
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 RIDGE WAY DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7461
Mailing Address - Country:US
Mailing Address - Phone:225-328-1665
Mailing Address - Fax:
Practice Address - Street 1:1333 RIDGE WAY DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7461
Practice Address - Country:US
Practice Address - Phone:225-328-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN110443163WD0400X, 363LF0000X
LA234256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator