Provider Demographics
NPI:1669185526
Name:MOORE, HEATHER NEELY (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NEELY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:910-737-3147
Mailing Address - Fax:
Practice Address - Street 1:2608 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9423
Practice Address - Country:US
Practice Address - Phone:919-735-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-13655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant