Provider Demographics
NPI:1760254692
Name:MOORE, ROBIN K (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EAU CLAIRE RD
Mailing Address - Street 2:
Mailing Address - City:EMLENTON
Mailing Address - State:PA
Mailing Address - Zip Code:16373-6317
Mailing Address - Country:US
Mailing Address - Phone:814-282-0324
Mailing Address - Fax:
Practice Address - Street 1:2 PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:833-604-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065162363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical