MEDICARE: EMILY 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
1	163W00000X	Registered Nurse	333962	NC
2	363LF0000X	Family Nurse Practitioner	5022785	NC

General Provider Information

NPI Number	:	1659266955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MOORE FNP-C

Provider Business Mailing Address
First Line	:	3925 FAWN CREEK DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-3271
Country	:	US
Telephone Number	:	910-742-3143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 OLEANDER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6821
Country	:	US
Telephone Number	:	910-202-6988
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	08/07/2025

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