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General NPI Number Information
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NPI Number | 1124726526
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Entity Type | Individual
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Provider Name | DEANNA SHATRICE MOORE
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1328 WEST BROAD STREET
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-828-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 COLTS PRIDE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-7004
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Country | US
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Telephone |
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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 | MOORE-38S85
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License Number State | NC
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