MEDICARE: MRS. BECKIE S MOORE CS FNP

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	RN107067	MO

General Provider Information

NPI Number	:	1457351710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKIE S MOORE CS FNP

Provider Business Mailing Address
First Line	:	601 S US HIGHWAY 169
Second Line	:	ATTN: ER
City	:	SMITHVILLE
State	:	MO
Zip	:	64089-9317
Country	:	US
Telephone Number	:	816-532-7706
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 S US HIGHWAY 169
Second Line	:	ATTN: ER
City	:	SMITHVILLE
State	:	MO
Zip	:	64089-9317
Country	:	US
Telephone Number	:	816-532-7706
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/11/2015

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