MEDICARE: FAITH KAREN MOORE C-NP

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	363LF0000X	Family Nurse Practitioner	APRN31705-FNP-BC	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00223942	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001719917	OTHER	WV	MS BCBS

General Provider Information

NPI Number	:	1407839897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH KAREN MOORE C-NP

Provider Business Mailing Address
First Line	:	445 RIVER BEND ESTATES RD
Second Line	:
City	:	PARSONS
State	:	WV
Zip	:	26287-8101
Country	:	US
Telephone Number	:	304-478-2022
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 RIVER BEND ESTATES RD
Second Line	:
City	:	PARSONS
State	:	WV
Zip	:	26287-8101
Country	:	US
Telephone Number	:	304-478-2022
Fax Number	:	304-454-9690

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/11/2015

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