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General NPI Number Information
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NPI Number | 1548833965
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Entity Type | Individual
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Provider Name | LARONDA LESHELL MOORE
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Gender | Female
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 111 W CHURCH ST
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City | QUITMAN
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State | MS
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Zip | 39355-2134
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Country | US
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Telephone | 601-604-3705
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Fax |
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Provider Business Mailing Address
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Address Line | 125 COUNTY ROAD 359
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City | MERIDIAN
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State | MS
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Zip | 39301-9676
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Country | US
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Telephone | 601-604-3705
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | MS
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