Provider Demographics
NPI:1184436404
Name:MOORE, DESARAYE MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:DESARAYE
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 COFER ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181-8209
Mailing Address - Country:US
Mailing Address - Phone:304-532-1818
Mailing Address - Fax:
Practice Address - Street 1:69 MAZE PLZ
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:WV
Practice Address - Zip Code:26143-5127
Practice Address - Country:US
Practice Address - Phone:304-598-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV113065163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management