Provider Demographics
NPI:1083134100
Name:MOORE, MELISSA LINDSEY (RN-BSN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LINDSEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PORTER ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-4067
Mailing Address - Country:US
Mailing Address - Phone:334-714-3468
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVE.
Practice Address - Street 2:
Practice Address - City:FT. RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095696163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical