Provider Demographics
NPI:1871001412
Name:MOORE, EMILY DAWN (CRNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DAWN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BYRD RD SE
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-5940
Mailing Address - Country:US
Mailing Address - Phone:256-566-4097
Mailing Address - Fax:
Practice Address - Street 1:1215 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3304
Practice Address - Country:US
Practice Address - Phone:256-973-4885
Practice Address - Fax:256-973-4805
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123706363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care