Provider Demographics
NPI:1831124932
Name:MOORE, BARBARA ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2004
Mailing Address - Country:US
Mailing Address - Phone:405-755-4050
Mailing Address - Fax:405-749-9566
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2004
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-749-9566
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0038335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113730AMedicaid
OK244513205Medicare ID - Type Unspecified
OK100113730AMedicaid
OKOK400014Medicare PIN