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General NPI Number Information
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NPI Number | 1528041381
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Entity Type | Individual
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Provider Name | BRANDI N MOORE PA
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Gender | Female
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 245 FORT CHISWELL RD STE D
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City | MAX MEADOWS
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State | VA
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Zip | 24360-3987
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Country | US
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Telephone | 276-613-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 POWDER MILL RD
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City | IVANHOE
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State | VA
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Zip | 24350-3559
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Country | US
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Telephone | 276-699-0105
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0110-002204
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-002204
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License Number State | VA
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