Provider Demographics
NPI:1750685558
Name:MOORE, MICHELE MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W CRISER RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2360
Mailing Address - Country:US
Mailing Address - Phone:540-636-4250
Mailing Address - Fax:540-636-7171
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-4250
Practice Address - Fax:540-636-7171
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001138275163WG0000X
VA0024169056363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice