Provider Demographics
NPI:1548242670
Name:MOORE, JOLEEN COMER (FNP)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:COMER
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOLEEN
Other - Middle Name:
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 BONNIE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3125
Mailing Address - Country:US
Mailing Address - Phone:910-716-0099
Mailing Address - Fax:910-405-1359
Practice Address - Street 1:211 BONNIE BROOK RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3125
Practice Address - Country:US
Practice Address - Phone:910-716-0099
Practice Address - Fax:910-405-1359
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22951363L00000X
NC201093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5422951OtherDHEC
SCNP6037Medicaid
SCNP6037Medicaid
NC7000127Medicaid
NC2591289COtherCIGNA GOV'T SERVICES MCR PTAN
NCNC8439AMedicare PIN
NC2591289COtherCIGNA GOV'T SERVICES MCR PTAN