Provider Demographics
NPI:1467454884
Name:MOORE, CARALYNN FAYE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARALYNN
Middle Name:FAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9275
Mailing Address - Country:US
Mailing Address - Phone:406-466-5165
Mailing Address - Fax:406-466-2536
Practice Address - Street 1:19 1ST ST NE
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9275
Practice Address - Country:US
Practice Address - Phone:406-466-5165
Practice Address - Fax:406-466-2536
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN5925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0437257Medicaid
MTS77077Medicare UPIN
000081061Medicare ID - Type Unspecified