Provider Demographics
NPI:1962474924
Name:MOORE, CHRISTOPHER HEATWOLE (MSN, RN, FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HEATWOLE
Last Name:MOORE
Suffix:
Gender:M
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5819
Mailing Address - Country:US
Mailing Address - Phone:540-564-5800
Mailing Address - Fax:757-440-3285
Practice Address - Street 1:640 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5819
Practice Address - Country:US
Practice Address - Phone:540-564-5800
Practice Address - Fax:757-440-3285
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001175642163W00000X
VA0024164912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7789564Medicaid
VA500000854Medicare PIN
P32780Medicare UPIN
500000854Medicare ID - Type Unspecified
VA002203C97Medicare PIN