Provider Demographics
NPI:1750809919
Name:MOORE, BERNICE LORETTA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:LORETTA
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-0663
Mailing Address - Country:US
Mailing Address - Phone:347-804-3685
Mailing Address - Fax:
Practice Address - Street 1:2412 GENTLE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3985
Practice Address - Country:US
Practice Address - Phone:347-804-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024091363LP0808X
PARN648046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse