Provider Demographics
NPI:1699134346
Name:MOORE, NANCY BEATRICE (WHNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BEATRICE
Last Name:MOORE
Suffix:
Gender:
Credentials:WHNP
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Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9203
Mailing Address - Country:US
Mailing Address - Phone:618-234-2390
Mailing Address - Fax:618-234-9936
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DEPT OBGYN, STE 341
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-454-7882
Practice Address - Fax:314-454-7882
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015043771363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420030426Medicaid