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General NPI Number Information
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NPI Number | 1649745241
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Entity Type | Individual
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Provider Name | CHERMAL RONDELL MOORE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 1017 W BEACON ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3218
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Country | US
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Telephone | 769-200-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 TALLABOGUE RD
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City | FOREST
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State | MS
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Zip | 39074-8592
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Country | US
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Telephone | 601-826-5561
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 902980
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License Number State | MS
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