MEDICARE: SCOTT EMORY MOORE APRN-CNP, AGPCNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0041841	OH

General Provider Information

NPI Number	:	1184062556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT EMORY MOORE APRN-CNP, AGPCNP-BC

Provider Business Mailing Address
First Line	:	4437 ROADOAN RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2745
Country	:	US
Telephone Number	:	864-430-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 ROADOAN RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2745
Country	:	US
Telephone Number	:	864-430-5093
Fax Number	:

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

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	03/26/2026

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