Healthcare Provider Details

I. General information

NPI: 1841934122
Provider Name (Legal Business Name): TOSHEENA MOORE HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 BERKMORE PL STE 2B
BERKELEY SPRINGS WV
25411-6247
US

IV. Provider business mailing address

939 BANKS RD UNIT 1
MARTINSVILLE VA
24112-2105
US

V. Phone/Fax

Practice location:
  • Phone: 304-433-8430
  • Fax:
Mailing address:
  • Phone: 276-968-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1159
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: