Provider Demographics
NPI:1457081846
Name:MOORE, CARLY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 FORT MISSOULA RD STE 146
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7401
Mailing Address - Country:US
Mailing Address - Phone:406-327-3850
Mailing Address - Fax:406-327-3851
Practice Address - Street 1:2831 FORT MISSOULA RD STE 146
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7401
Practice Address - Country:US
Practice Address - Phone:406-327-3850
Practice Address - Fax:406-327-3851
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-195589363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-APRN-LIC-195589OtherMONTANA APRN LICENSE