Provider Demographics
NPI:1508327537
Name:MOORE, MICHAEL D (APRN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-9240
Mailing Address - Country:US
Mailing Address - Phone:606-919-1901
Mailing Address - Fax:606-919-1904
Practice Address - Street 1:1031 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9240
Practice Address - Country:US
Practice Address - Phone:606-919-1901
Practice Address - Fax:606-919-1904
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily