MEDICARE: WHITNEY W MOORE NP-C

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
1	363L00000X	Nurse Practitioner	R866158	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164689071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY W MOORE NP-C

Provider Business Mailing Address
First Line	:	14213 COOK RD BLDG A
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39532-9719
Country	:	US
Telephone Number	:	228-575-2545
Fax Number	:	228-872-8029

Provider Business Practice Location Address
First Line	:	11700 HIGHWAY 57
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-8309
Country	:	US
Telephone Number	:	228-826-1482
Fax Number	:	228-826-5924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	06/12/2024

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Directions to “ WHITNEY W MOORE NP-C” Practice Location

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