Healthcare Provider Details

I. General information

NPI: 1275586414
Provider Name (Legal Business Name): MEGHAN E MOORE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 KINGSTOWN RD
NARRAGANSETT RI
02882-3258
US

IV. Provider business mailing address

360 KINGSTOWN RD
NARRAGANSETT RI
02882-3258
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN00487
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: