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General NPI Number Information
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NPI Number | 1033531181
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Entity Type | Individual
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Provider Name | TINA MOORE NP
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Gender | Female
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1860 N CHURCH RD
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-415-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 6398 SE RHODUS LN
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City | LAWSON
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State | MO
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Zip | 64062-7212
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Country | US
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Telephone | 816-918-8201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2014000703
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License Number State | MO
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