Provider Demographics
NPI:1720593908
Name:MOORE, LATORYA DELOIS (MSN, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LATORYA
Middle Name:DELOIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:514 N BRIGHTLEAF BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4487
Mailing Address - Country:US
Mailing Address - Phone:919-989-2192
Mailing Address - Fax:919-934-0006
Practice Address - Street 1:514 N BRIGHTLEAF BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-989-2192
Practice Address - Fax:919-934-0006
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5010083363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health