Healthcare Provider Details

I. General information

NPI: 1336697754
Provider Name (Legal Business Name): DAVID MOES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 HARBOR DR
CALABASH NC
28467-2300
US

IV. Provider business mailing address

1072 HARBOR DR
CALABASH NC
28467-2300
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-0344
  • Fax:
Mailing address:
  • Phone: 919-810-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009156
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015141
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number149745
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: