Healthcare Provider Details

I. General information

NPI: 1891969523
Provider Name (Legal Business Name): MEGAN J MOORE PA-S; RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN J PATTERSON RD

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W SPRING ST SUITE 300
SYLACAUGA AL
35150-2973
US

IV. Provider business mailing address

209 W SPRING ST SUITE 300
SYLACAUGA AL
35150-2973
US

V. Phone/Fax

Practice location:
  • Phone: 256-208-0060
  • Fax: 255-208-0755
Mailing address:
  • Phone: 256-208-0060
  • Fax: 256-208-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.882
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1913
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: