Provider Demographics
NPI:1518682186
Name:MOORE, BA'SHARRA ANEKA (NP)
Entity Type:Individual
Prefix:
First Name:BA'SHARRA
Middle Name:ANEKA
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:890 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6863
Mailing Address - Country:US
Mailing Address - Phone:478-745-4322
Mailing Address - Fax:478-254-3629
Practice Address - Street 1:890 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6863
Practice Address - Country:US
Practice Address - Phone:478-745-4322
Practice Address - Fax:478-254-3629
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN252151163WN0300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology