Healthcare Provider Details

I. General information

NPI: 1649731621
Provider Name (Legal Business Name): SABRINA ANN MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W BANKHEAD ST
NEW ALBANY MS
38652-3319
US

IV. Provider business mailing address

460 W BANKHEAD ST
NEW ALBANY MS
38652-3319
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-1404
  • Fax:
Mailing address:
  • Phone: 662-539-7444
  • Fax: 662-837-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904271
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR827207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: