Provider Demographics
NPI:1467051888
Name:MOORE, REBECCA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1205
Mailing Address - Country:US
Mailing Address - Phone:641-255-2970
Mailing Address - Fax:860-413-0960
Practice Address - Street 1:1208 E CROSS ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-3501
Practice Address - Country:US
Practice Address - Phone:641-255-2970
Practice Address - Fax:860-413-0960
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA161167363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care