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General NPI Number Information
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NPI Number | 1699183756
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Entity Type | Organization
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Legal Business Name | MOORE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 490 SAINT ANDREWS DR SUITE 106
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City | MURFREESBORO
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State | TN
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Zip | 37128-6578
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Country | US
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Telephone | 615-896-4482
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Fax | 615-896-4472
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Provider Business Mailing Address
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Address Line | 490 SAINT ANDREWS DR SUITE 106
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City | MURFREESBORO
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State | TN
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Zip | 37128-6578
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Country | US
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Telephone | 615-896-4482
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Fax | 615-896-4472
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY MOORE
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Credential | NP
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Telephone | 615-896-4482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 7885
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7533
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License Number State | TN
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