Provider Demographics
NPI:1619444544
Name:MOORE, ALYSIA NICOLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:ALYSIA
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 RIVERCHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1777
Mailing Address - Country:US
Mailing Address - Phone:803-329-2636
Mailing Address - Fax:803-329-2184
Practice Address - Street 1:1436 RIVERCHASE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1777
Practice Address - Country:US
Practice Address - Phone:803-329-2636
Practice Address - Fax:803-329-2184
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22354363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care