Provider Demographics
NPI:1326101791
Name:MOORE, TERRE LYNN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRE
Middle Name:LYNN
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 1:1007 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-3149
Mailing Address - Country:US
Mailing Address - Phone:334-287-2910
Mailing Address - Fax:334-295-8313
Practice Address - Street 1:1007 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-3149
Practice Address - Country:US
Practice Address - Phone:334-287-2910
Practice Address - Fax:334-295-8313
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-045972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1436OtherPRESCRIPTIVE#
AL1-045972OtherAL LICENSE#
AL1436OtherPRESCRIPTIVE#
AL58905-COWMedicare ID - Type UnspecifiedPROVIDER#
AL58905-COWMedicaid
ALP02152ALMedicare UPIN
ALP02152Medicare UPIN