Provider Demographics
NPI:1669782470
Name:MOORING, SHANNON BRITTAIN (ANP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BRITTAIN
Last Name:MOORING
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5420 WADE PARK BLVD
Mailing Address - Street 2:STE. 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4188
Mailing Address - Country:US
Mailing Address - Phone:919-851-2174
Mailing Address - Fax:919-854-7774
Practice Address - Street 1:910 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4751
Practice Address - Country:US
Practice Address - Phone:919-989-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004923363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2595020Medicare PIN