Provider Demographics
NPI:1235724311
Name:MOORE, CHAVONA PRINSHAY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CHAVONA
Middle Name:PRINSHAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107
Mailing Address - Country:US
Mailing Address - Phone:334-420-5001
Mailing Address - Fax:334-420-0160
Practice Address - Street 1:1845 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:334-420-0160
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily