Provider Demographics
NPI:1912998931
Name:MOORE, VICKIE B (FNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:B
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:B
Other - Last Name:CHIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 2445
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-2445
Mailing Address - Country:US
Mailing Address - Phone:828-277-1300
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:14 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-255-3749
Practice Address - Fax:828-254-9925
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201068363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004051Medicaid
NC7004051Medicaid