Healthcare Provider Details

I. General information

NPI: 1467567255
Provider Name (Legal Business Name): SHERRY M MOORE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PRIME CARE DRIVE
SELMER TN
38375
US

IV. Provider business mailing address

ONE PRIME CARE DRIVE PRIME CARE MEDICAL CENTER
SELMER TN
38375
US

V. Phone/Fax

Practice location:
  • Phone: 731-645-7932
  • Fax: 731-645-5195
Mailing address:
  • Phone: 731-645-7932
  • Fax: 731-645-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN05064
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN027447
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: