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NPI Code Detail

MEDICARE: MRS. MISTI NICOLE MOON

MEDICARE: MRS. MISTI NICOLE MOON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3654OK

General Provider Information

NPI Number : 1093082026
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MISTI NICOLE MOON
Provider Business Mailing Address
First Line : 14429 ASHWOOD CT
Second Line :
City : EDMOND
State : OK
Zip : 73025-2240
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6905 NW 122ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-3903
Country : US
Telephone Number : 405-603-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2011
Last Update Date : 03/23/2016

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Directions to “ MRS. MISTI NICOLE MOON ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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