Provider Demographics
NPI:1407839897
Name:MOORE, FAITH KAREN (C-NP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:KAREN
Last Name:MOORE
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 RIVER BEND ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-8101
Mailing Address - Country:US
Mailing Address - Phone:304-478-2022
Mailing Address - Fax:
Practice Address - Street 1:445 RIVER BEND ESTATES RD
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-8101
Practice Address - Country:US
Practice Address - Phone:304-478-2022
Practice Address - Fax:304-454-9690
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN31705-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00223942OtherRR MEDICARE
WV3810001436Medicaid
WV001719917OtherMS BCBS
WV2029991Medicare PIN
WV001719917OtherMS BCBS
WVQ32418Medicare UPIN
WVP00638244Medicare PIN