Provider Demographics
NPI:1518683192
Name:MOORE, YOLYNDA JASMINE
Entity Type:Individual
Prefix:
First Name:YOLYNDA
Middle Name:JASMINE
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 1:15 OTTER CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-9735
Mailing Address - Country:US
Mailing Address - Phone:919-908-3841
Mailing Address - Fax:
Practice Address - Street 1:15 OTTER CT
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9735
Practice Address - Country:US
Practice Address - Phone:919-908-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home