Healthcare Provider Details

I. General information

NPI: 1316725351
Provider Name (Legal Business Name): SHERRI MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 S LAKE DR
LEXINGTON SC
29072-3703
US

IV. Provider business mailing address

332 WHETSTONE RD
SWANSEA SC
29160-9270
US

V. Phone/Fax

Practice location:
  • Phone: 803-312-5284
  • Fax:
Mailing address:
  • Phone: 803-312-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201286
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: