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General NPI Number Information
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NPI Number | 1215369905
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Entity Type | Organization
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Legal Business Name | THE WOMEN'S PAVILION, PSC APRN GROUP
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 2200 E PARRISH AVE STE 201 BLDG B
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-926-3700
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Fax | 270-926-2114
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE STE 201 BLDG B
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-926-3700
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Fax | 270-926-2114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA B MOORE
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Credential | M.D.
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Telephone | 270-926-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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