Provider Demographics
NPI:1891339099
Name:MOORE, SHAKILA (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAKILA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 ELLIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35221-1407
Mailing Address - Country:US
Mailing Address - Phone:205-249-3242
Mailing Address - Fax:
Practice Address - Street 1:3537 ELLIS AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35221-1407
Practice Address - Country:US
Practice Address - Phone:205-249-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159990163WP0808X, 363LP0808X
FLAPRN11004913363L00000X, 363LP0808X
GARN300940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner