Provider Demographics
NPI:1790196111
Name:MOORE, SHERI DENISE (NP)
Entity type:Individual
Prefix:MS
First Name:SHERI
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 NEW CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-2833
Mailing Address - Country:US
Mailing Address - Phone:434-660-0633
Mailing Address - Fax:
Practice Address - Street 1:14005 WARDS RD STE A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-7127
Practice Address - Country:US
Practice Address - Phone:434-239-0132
Practice Address - Fax:434-239-0490
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171849363LF0000X
VA0001174230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse