Healthcare Provider Details

I. General information

NPI: 1699134346
Provider Name (Legal Business Name): NANCY BEATRICE MOORE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR STE 240
BELLEVILLE IL
62226-5363
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2390
  • Fax:
Mailing address:
  • Phone: 618-234-2390
  • Fax: 618-234-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2015043771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: