Provider Demographics
NPI:1891969523
Name:MOORE, MEGAN J (PA-S; RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-S; RD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:J
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-208-0060
Mailing Address - Fax:256-208-0755
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-208-0060
Practice Address - Fax:255-208-0755
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1913133V00000X
ALPA.882363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPA.882OtherNCCPA
AL165866Medicaid
AL1913OtherAL BOARD DIET/NUT
AL989061OtherCDR