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NPI Code Detail

MEDICARE: CHARLOTTE MOORE FNP-C

MEDICARE:   CHARLOTTE  MOORE  FNP-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
1363LF0000XFamily Nurse Practitioner2015009949MO

General Provider Information

NPI Number : 1598158693
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE MOORE FNP-C
Provider Business Mailing Address
First Line : 22 BRIXWORTH CT
Second Line :
City : BLACK JACK
State : MO
Zip : 63033-7438
Country : US
Telephone Number : 314-393-6693
Fax Number :
Provider Business Practice Location Address
First Line : 13655 RIVERPORT DR
Second Line :
City : MARYLAND HTS
State : MO
Zip : 63043-4812
Country : US
Telephone Number : 314-592-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2015
Last Update Date : 01/27/2022

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Directions to “ CHARLOTTE MOORE FNP-C” Practice Location

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