Provider Demographics
NPI:1922566256
Name:MOORE, CEOLA P
Entity Type:Individual
Prefix:
First Name:CEOLA
Middle Name:P
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 N PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWHEBRON
Mailing Address - State:MS
Mailing Address - Zip Code:39140-4028
Mailing Address - Country:US
Mailing Address - Phone:601-260-4277
Mailing Address - Fax:
Practice Address - Street 1:628 N PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:NEWHEBRON
Practice Address - State:MS
Practice Address - Zip Code:39140-4028
Practice Address - Country:US
Practice Address - Phone:601-260-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse