Healthcare Provider Details

I. General information

NPI: 1326479841
Provider Name (Legal Business Name): MARY BETH MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHNSON RD STE 208
STEUBENVILLE OH
43952-2372
US

IV. Provider business mailing address

4100 JOHNSON RD STE 208
STEUBENVILLE OH
43952-2372
US

V. Phone/Fax

Practice location:
  • Phone: 740-314-5138
  • Fax: 740-792-4171
Mailing address:
  • Phone: 740-314-5138
  • Fax: 740-792-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: