Provider Demographics
NPI:1447583869
Name:MOYER, LARRY (RN)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7861 SE FREEWAY FARMS DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MO
Mailing Address - Zip Code:64048-8404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7861 SE FREEWAY FARMS DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MO
Practice Address - Zip Code:64048-8404
Practice Address - Country:US
Practice Address - Phone:816-588-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023704163W00000X
KS14-104413-111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse