Provider Demographics
NPI:1992004345
Name:MOORE, CHRISTY MICHELLE (RD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W GARRARD RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2050
Mailing Address - Country:US
Mailing Address - Phone:662-324-8300
Mailing Address - Fax:662-324-7590
Practice Address - Street 1:104 W GARRARD RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2050
Practice Address - Country:US
Practice Address - Phone:662-324-8300
Practice Address - Fax:662-324-7590
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered