Provider Demographics
NPI:1114491057
Name:MOORE, MONICA BOSWELL (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:BOSWELL
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:BOSWELL
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:95 COUNTY ROAD 820
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701
Mailing Address - Country:US
Mailing Address - Phone:334-412-6372
Mailing Address - Fax:334-418-4269
Practice Address - Street 1:1015 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-418-4150
Practice Address - Fax:334-418-3592
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily