Provider Demographics
NPI:1821396946
Name:MOORE, BRIAN CLAYTON (ARNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CLAYTON
Last Name:MOORE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:OK
Mailing Address - Zip Code:73567-0070
Mailing Address - Country:US
Mailing Address - Phone:580-365-4533
Mailing Address - Fax:
Practice Address - Street 1:8148 STATE HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-9010
Practice Address - Country:US
Practice Address - Phone:580-454-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily