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General NPI Number Information
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NPI Number | 1154296408
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Entity Type | Organization
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Legal Business Name | MORE WELLNESS MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 4019 COBBLEWOOD DR
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City | DISPUTANTA
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State | VA
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Zip | 23842-4518
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Country | US
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Telephone | 757-724-7310
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Fax | 757-724-7310
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Provider Business Mailing Address
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Address Line | 4019 COBBLEWOOD DR
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City | DISPUTANTA
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State | VA
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Zip | 23842-4518
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Country | US
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Telephone | 757-724-7310
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Fax | 757-724-7310
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. TERA N MOORE
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Credential | NP
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Telephone | 757-724-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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