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General NPI Number Information
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NPI Number | 1689068751
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Entity Type | Individual
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Provider Name | LISA MOORE NP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 748 ADDINGTON DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-7102
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Country | US
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Telephone | 252-481-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 748 ADDINGTON DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-7102
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Country | US
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Telephone | 252-414-3318
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Fax | 252-677-6551
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 208959
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License Number State | NC
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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 | 0024193436
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5007549
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License Number State | NC
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