Provider Demographics
NPI:1881660371
Name:MOORE, HELEN MILLER (PA)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:MILLER
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:FRANCILLA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1930 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1185
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:276-883-8075
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005141363A00000X
NC100812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01680339OtherRAILROAD MEDICARE
VA1881660371Medicaid
TNQ018823Medicaid
VA1881660371Medicaid