Provider Demographics
NPI:1346395977
Name:MOORE, SHARON E (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
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 1771
Mailing Address - Street 2:CEMETARY ROAD
Mailing Address - City:KILDARE
Mailing Address - State:TX
Mailing Address - Zip Code:75562-1771
Mailing Address - Country:US
Mailing Address - Phone:903-796-1019
Mailing Address - Fax:
Practice Address - Street 1:YOUREE DRIVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:318-212-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse