Healthcare Provider Details

I. General information

NPI: 1073760864
Provider Name (Legal Business Name): DONNA H MOORE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MERCHANTS WALK
SUMMERSVILLE WV
26651-1901
US

IV. Provider business mailing address

PO BOX 1049
LEWISBURG WV
24901-4049
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-9455
  • Fax:
Mailing address:
  • Phone: 304-645-4043
  • Fax: 304-645-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number48550
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number48550
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: