Provider Demographics
NPI:1396015772
Name:MOORE, VIRGINIA JEANNE KEARNEY (PA-C)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JEANNE KEARNEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6488 WEDDINGTON MONROE RD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104-7948
Practice Address - Country:US
Practice Address - Phone:704-316-5650
Practice Address - Fax:704-316-5651
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-03223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant