Healthcare Provider Details

I. General information

NPI: 1497448054
Provider Name (Legal Business Name): HALEY N MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

100 STOOPS DR
MONONGAHELA PA
15063-3553
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-1000
  • Fax:
Mailing address:
  • Phone: 724-483-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA064586
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: