Provider Demographics
NPI:1639585045
Name:MOORES, PRISCILA (APRN)
Entity Type:Individual
Prefix:
First Name:PRISCILA
Middle Name:
Last Name:MOORES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PRISCILA
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:16317 BRAVADO PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2207
Mailing Address - Country:US
Mailing Address - Phone:405-361-2250
Mailing Address - Fax:405-495-7825
Practice Address - Street 1:4510 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-2503
Practice Address - Country:US
Practice Address - Phone:405-495-5841
Practice Address - Fax:405-495-7825
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704320224363LF0000X
OK000000363LF0000X
OK97357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily