Provider Demographics
NPI:1659633717
Name:MOORE, DEANDRA KAY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEANDRA
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DEANDRA
Other - Middle Name:KAY
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1325 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201
Mailing Address - Country:US
Mailing Address - Phone:256-741-1339
Mailing Address - Fax:256-741-1356
Practice Address - Street 1:1325 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201
Practice Address - Country:US
Practice Address - Phone:256-741-1339
Practice Address - Fax:256-741-1356
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner