Provider Demographics
NPI:1669914826
Name:MOORE, RHONDA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24345 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-8575
Mailing Address - Country:US
Mailing Address - Phone:601-747-8211
Mailing Address - Fax:601-774-8321
Practice Address - Street 1:24345 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-8575
Practice Address - Country:US
Practice Address - Phone:601-774-8211
Practice Address - Fax:601-774-8589
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871925363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology