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General NPI Number Information
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NPI Number | 1043615644
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Entity Type | Individual
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Provider Name | KRISTINA MOORE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 100 PHYSICIANS WAY SUITE 110
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City | LEBANON
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State | TN
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Zip | 37090-8102
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Country | US
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Telephone | 615-547-6700
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Fax | 615-547-6707
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone |
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Fax | 706-494-3008
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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