Provider Demographics
NPI:1114038809
Name:MOORE, JULIE A (RNC, LIMHP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 AVENUE A
Mailing Address - Street 2:SUITE E
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8169
Mailing Address - Country:US
Mailing Address - Phone:308-234-5644
Mailing Address - Fax:308-234-5652
Practice Address - Street 1:3720 AVENUE A
Practice Address - Street 2:SUITE E
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8169
Practice Address - Country:US
Practice Address - Phone:308-234-5644
Practice Address - Fax:308-234-5652
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1012101YM0800X
NE30084163WP0808X
NE391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829229Medicaid
NE94077OtherBC/BS
NE470808292OtherMIDLANDS CHOICE
NE348783000OtherMAGELLAN MIS
NE47080829228Medicaid
NE470808292OtherTRICARE