Provider Demographics
NPI:1497351993
Name:MOORE, COURTNEY ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ELAINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:ELAINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COURTNEY ROWE
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-356-5000
Mailing Address - Fax:
Practice Address - Street 1:835 W EMMITT AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1190
Practice Address - Country:US
Practice Address - Phone:740-947-7662
Practice Address - Fax:740-941-0099
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHARN.CNP.0027818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner