Provider Demographics
NPI:1255209862
Name:MOORE, TIERRA LA'SHAY (FNP)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:LA'SHAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4906
Mailing Address - Country:US
Mailing Address - Phone:252-940-0602
Mailing Address - Fax:
Practice Address - Street 1:120 W MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4906
Practice Address - Country:US
Practice Address - Phone:252-940-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5023360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily