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General NPI Number Information
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NPI Number | 1972152197
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Entity Type | Individual
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Provider Name | MALLORY MOORE DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2604 DR MARTIN LUTHER KING JR BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-4238
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Country | US
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Telephone | 252-638-4023
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Fax | 252-633-2833
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | POLLOCKSVILLE
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State | NC
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Zip | 28573-0068
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Country | US
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Telephone | 252-276-7706
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Fax | 252-224-0378
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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 | 5015120
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License Number State | NC
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