Healthcare Provider Details

I. General information

NPI: 1841613841
Provider Name (Legal Business Name): BEULAH MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 ULLOA ST
NEW ORLEANS LA
70119-6942
US

IV. Provider business mailing address

1500 LORENE DR APT 196 APT. 196
HARVEY LA
70058-3332
US

V. Phone/Fax

Practice location:
  • Phone: 605-377-6712
  • Fax: 504-267-5714
Mailing address:
  • Phone: 504-214-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number5340
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5340
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: