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General NPI Number Information
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NPI Number | 1740072768
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Entity Type | Individual
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Provider Name | LAMARCUS MOORE
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1110 RINGGOLD AVE STE B
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City | COUSHATTA
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State | LA
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Zip | 71019-9004
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Country | US
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Telephone | 318-932-1770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 921
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City | COUSHATTA
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State | LA
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Zip | 71019-0921
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Country | US
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Telephone | 318-214-7948
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN154244
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License Number State | LA
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