Healthcare Provider Details

I. General information

NPI: 1740072768
Provider Name (Legal Business Name): LAMARCUS MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KENNETH ST
RINGGOLD LA
71068-2585
US

IV. Provider business mailing address

PO BOX 921
COUSHATTA LA
71019-0921
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-7948
  • Fax:
Mailing address:
  • Phone: 318-214-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number244389
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number244389
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: