Healthcare Provider Details

I. General information

NPI: 1871826610
Provider Name (Legal Business Name): ELIZABETH J MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 ALLISONVILLE RD STE 240
FISHERS IN
46038-2634
US

IV. Provider business mailing address

2514 OAK PARK COURT
RICHMOND IN
47374-1282
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 774-285-0822
  • Fax: 765-966-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28087121A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71005185B
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71005185A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71005185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: