Provider Demographics
NPI:1114709730
Name:MOORE, TEEYANA PRECIOUS (BS)
Entity Type:Individual
Prefix:
First Name:TEEYANA
Middle Name:PRECIOUS
Last Name:MOORE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KEEYANA
Other - Middle Name:ARMANI
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8215 CARTER CREEK DR APT 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4727
Mailing Address - Country:US
Mailing Address - Phone:704-713-2804
Mailing Address - Fax:
Practice Address - Street 1:8215 CARTER CREEK DR APT 301
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-4727
Practice Address - Country:US
Practice Address - Phone:704-713-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty