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General NPI Number Information
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NPI Number | 1164904397
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Entity Type | Individual
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Provider Name | JAMES R MOORE
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Gender | Male
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 326 N LOCUST AVE STE B
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3516
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Country | US
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Telephone | 931-762-9797
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Fax | 931-762-9798
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Provider Business Mailing Address
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Address Line | 326 N LOCUST AVE STE B
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3516
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Country | US
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Telephone | 931-762-9797
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Fax | 931-762-9798
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F07180975
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License Number State | TN
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