Healthcare Provider Details

I. General information

NPI: 1942678529
Provider Name (Legal Business Name): SUSAN LYNN MOORE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2015
Last Update Date: 05/13/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N FRONT STREET
OAK HILL OH
45656
US

IV. Provider business mailing address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-682-3888
  • Fax: 740-395-8879
Mailing address:
  • Phone: 740-446-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: