=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699134346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY BEATRICE MOORE WHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 11/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 MEMORIAL DR STE 240
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-234-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 959203
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63195-9203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-234-2390
-----------------------------------------------------
Fax | 618-234-9936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 2015043771
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------