Provider Demographics
NPI:1932463288
Name:MOORE, AMANDA DAVIS (MSN, APRN, ANP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAVIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, APRN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10880 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3909
Mailing Address - Country:US
Mailing Address - Phone:225-367-4122
Mailing Address - Fax:225-367-4092
Practice Address - Street 1:10880 JOOR RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3909
Practice Address - Country:US
Practice Address - Phone:225-367-4122
Practice Address - Fax:225-367-4092
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATAP002933363LA2200X
LAAP06967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health