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General NPI Number Information
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NPI Number | 1316370992
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Entity Type | Individual
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Provider Name | ZACHARY DAVID MOORE FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/18/2013
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1 KENTON DR STE 200
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City | CHARLESTON
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State | WV
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Zip | 25311-1256
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Country | US
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Telephone | 304-513-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 2585 3RD AVE
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City | HUNTINGTON
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State | WV
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Zip | 25703-1642
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Country | US
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Telephone | 304-697-1396
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Fax | 304-697-2086
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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 | 72998
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN72998
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License Number State | WV
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