Provider Demographics
NPI:1578326658
Name:MOORE, CASIE LEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VICTOR DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5091
Mailing Address - Country:US
Mailing Address - Phone:573-391-0499
Mailing Address - Fax:
Practice Address - Street 1:1500 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4838
Practice Address - Country:US
Practice Address - Phone:573-391-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health