Provider Demographics
NPI:1396015772
Name:MOORE, VIRGINIA JEANNE KEARNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JEANNE KEARNEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SALLY CRAB CT
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9199
Mailing Address - Country:US
Mailing Address - Phone:252-916-6697
Mailing Address - Fax:
Practice Address - Street 1:130 SALLY CRAB CT
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9199
Practice Address - Country:US
Practice Address - Phone:252-916-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant