Healthcare Provider Details

I. General information

NPI: 1326432287
Provider Name (Legal Business Name): LEE MOORE DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N LAKEWOOD AVE
BALTIMORE MD
21224-1143
US

IV. Provider business mailing address

156 N LAKEWOOD AVE
BALTIMORE MD
21224-1143
US

V. Phone/Fax

Practice location:
  • Phone: 410-417-8334
  • Fax: 804-999-0621
Mailing address:
  • Phone: 410-417-8334
  • Fax: 804-999-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181190
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001301606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: