Healthcare Provider Details

I. General information

NPI: 1093641706
Provider Name (Legal Business Name): CORINNE MOORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 PEARL ST
AMO IN
46103-7724
US

IV. Provider business mailing address

PO BOX 183
AMO IN
46103-0183
US

V. Phone/Fax

Practice location:
  • Phone: 317-445-2695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28198928A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: