Provider Demographics
NPI:1194183384
Name:MOORE, DANA HARRISON (PMHNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:HARRISON
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 BOYDTON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-2851
Mailing Address - Country:US
Mailing Address - Phone:434-949-7211
Mailing Address - Fax:
Practice Address - Street 1:108 S BRAGG ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-2048
Practice Address - Country:US
Practice Address - Phone:828-655-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001225093163W00000X
VA0024185922363LP0808X
NC5017850363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse