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General NPI Number Information
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NPI Number | 1386280592
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Entity Type | Individual
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Provider Name | LILY MOORE
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 515 E MARKET ST APT 502
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-3051
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Country | US
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Telephone | 317-696-8404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2213
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City | CLARKSVILLE
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State | IN
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Zip | 47131-2213
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Country | US
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Telephone | 812-284-2273
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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 | 71009935A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2019051245
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License Number State | IN
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