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General NPI Number Information
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NPI Number | 1881158434
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Entity Type | Individual
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Provider Name | NIKKI LYNN MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 535 E MAIN ST
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City | GRAYSON
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State | KY
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Zip | 41143-1444
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Country | US
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Telephone | 606-314-0053
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Fax | 606-212-0226
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Provider Business Mailing Address
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Address Line | 535 E MAIN ST
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City | GRAYSON
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State | KY
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Zip | 41143-1444
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Country | US
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Telephone | 606-314-0053
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Fax | 606-212-0226
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3013092
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 113996
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License Number State | WV
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