Provider Demographics
NPI:1003090150
Name:MOORE, DONNA A (APRN-C, PMHNP-BC, MS)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:A
Last Name:MOORE
Suffix:
Gender:
Credentials:APRN-C, PMHNP-BC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 MADISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7940
Mailing Address - Country:US
Mailing Address - Phone:516-493-2203
Mailing Address - Fax:
Practice Address - Street 1:915 INTERSTATE RIDGE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7076
Practice Address - Country:US
Practice Address - Phone:516-493-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5796691163W00000X
GARN241756363LA2200X, 363LP0808X
CA95029693363LA2200X
FL11034073363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care