Provider Demographics
NPI:1982844460
Name:MOORE, SHELLEY MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 FIREHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-5733
Mailing Address - Country:US
Mailing Address - Phone:256-839-6087
Mailing Address - Fax:
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 107
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-212-9300
Practice Address - Fax:256-212-9363
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-074273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily