Provider Demographics
NPI:1922757426
Name:MOORE, BARBARA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LARKSPUR LN STE D
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2753
Mailing Address - Country:US
Mailing Address - Phone:276-236-6341
Mailing Address - Fax:276-236-6237
Practice Address - Street 1:140 LARKSPUR LN STE D
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2753
Practice Address - Country:US
Practice Address - Phone:276-236-6341
Practice Address - Fax:276-236-6237
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002078442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse