Provider Demographics
NPI:1427560531
Name:MOORE, WHITNEY JACKSON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:JACKSON
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-0219
Mailing Address - Country:US
Mailing Address - Phone:931-593-2277
Mailing Address - Fax:931-593-2517
Practice Address - Street 1:236 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOBELVILLE
Practice Address - State:TN
Practice Address - Zip Code:37097-3296
Practice Address - Country:US
Practice Address - Phone:931-593-2277
Practice Address - Fax:931-593-2517
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner