Provider Demographics
NPI:1467567255
Name:MOORE, SHERRY M (CFNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE PRIME CARE DRIVE
Mailing Address - Street 2:PRIME CARE MEDICAL CENTER
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375
Mailing Address - Country:US
Mailing Address - Phone:731-645-7932
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:ONE PRIME CARE DRIVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375
Practice Address - Country:US
Practice Address - Phone:731-645-7932
Practice Address - Fax:731-645-5195
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05064363LF0000X
TNRN027447163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
4038058OtherBLUE CROSS BLUE SHIELD
TN23178OtherTLC
3341359Medicare ID - Type Unspecified
4038058OtherBLUE CROSS BLUE SHIELD