Healthcare Provider Details

I. General information

NPI: 1942629944
Provider Name (Legal Business Name): PATRICIA N. MOORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CHESTERFIELD HWY
CHERAW SC
29520-7001
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-2171
  • Fax: 843-537-5926
Mailing address:
  • Phone: 843-777-7098
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18771
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: