Provider Demographics
NPI:1184392839
Name:MOORE, MEGAN NIEMYER (DNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NIEMYER
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8747
Mailing Address - Country:US
Mailing Address - Phone:910-715-3500
Mailing Address - Fax:910-715-3551
Practice Address - Street 1:135 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8747
Practice Address - Country:US
Practice Address - Phone:910-715-3500
Practice Address - Fax:910-715-3741
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014852363L00000X
NCAG06200290363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology