Provider Demographics
NPI:1184046914
Name:MOORE, CHRISTINA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 KIMBLE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7154
Mailing Address - Country:US
Mailing Address - Phone:317-883-1596
Mailing Address - Fax:
Practice Address - Street 1:7245 KIMBLE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-7154
Practice Address - Country:US
Practice Address - Phone:317-883-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28162943A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily