Provider Demographics
NPI:1750661872
Name:MOORE, JUDY ANN (RN MS)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13484 W OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-8282
Mailing Address - Country:US
Mailing Address - Phone:918-289-4750
Mailing Address - Fax:
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7602
Practice Address - Country:US
Practice Address - Phone:918-245-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR44657163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health