Provider Demographics
NPI:1578298212
Name:MOORE, HEATHER RACHELE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RACHELE
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 1:900 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1810
Mailing Address - Country:US
Mailing Address - Phone:304-942-5237
Mailing Address - Fax:304-908-9970
Practice Address - Street 1:1715 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3843
Practice Address - Country:US
Practice Address - Phone:304-942-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No175T00000XOther Service ProvidersPeer Specialist