Provider Demographics
NPI:1518566546
Name:MOORE, AMANDA FAYE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 POPLAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-3851
Mailing Address - Country:US
Mailing Address - Phone:304-701-8463
Mailing Address - Fax:
Practice Address - Street 1:609 POPLAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-3851
Practice Address - Country:US
Practice Address - Phone:304-701-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant