Provider Demographics
NPI:1275118465
Name:MOORE, JUDY C
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:WV
Mailing Address - Zip Code:26210-0212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 KATEFIELD DR
Practice Address - Street 2:
Practice Address - City:FRENCH CREEK
Practice Address - State:WV
Practice Address - Zip Code:26218
Practice Address - Country:US
Practice Address - Phone:304-439-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker