Healthcare Provider Details

I. General information

NPI: 1972152197
Provider Name (Legal Business Name): MALLORY MOORE DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 DR MARTIN LUTHER KING JR BLVD
NEW BERN NC
28562-4238
US

IV. Provider business mailing address

PO BOX 68
POLLOCKSVILLE NC
28573-0068
US

V. Phone/Fax

Practice location:
  • Phone: 252-638-4023
  • Fax: 252-633-2833
Mailing address:
  • Phone: 252-276-7706
  • Fax: 252-224-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015120
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: