MEDICARE: MOOREHALTH

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1366172843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOOREHALTH

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	COOKSTOWN
State	:	NJ
Zip	:	08511-0188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 MARLTON PIKE W
Second Line	:	#407
City	:	MARLTON
State	:	NJ
Zip	:	08053-2075
Country	:	US
Telephone Number	:	347-912-7566
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	OLIVER MOORE
Credential	:	DNP
Telephone Number	:	267-804-1575

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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Directions to “MOOREHALTH ” Practice Location

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