Healthcare Provider Details

I. General information

NPI: 1902055197
Provider Name (Legal Business Name): NATALIE HERRINGTON MOORE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MEDICAL CENTER DR
BATESVILLE MS
38606-8608
US

IV. Provider business mailing address

155 KEATING RD
BATESVILLE MS
38606-2901
US

V. Phone/Fax

Practice location:
  • Phone: 662-712-2248
  • Fax: 662-712-2180
Mailing address:
  • Phone: 662-712-1460
  • Fax: 662-563-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR865994
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: