Provider Demographics
NPI:1821457656
Name:MOORE, ANEESHA JANET
Entity Type:Individual
Prefix:MS
First Name:ANEESHA
Middle Name:JANET
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANEESHA
Other - Middle Name:JANET
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA SOCIOLOGY
Mailing Address - Street 1:PO BOX 300254
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-0254
Mailing Address - Country:US
Mailing Address - Phone:405-640-8495
Mailing Address - Fax:
Practice Address - Street 1:3945 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115
Practice Address - Country:US
Practice Address - Phone:405-208-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker