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General NPI Number Information
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NPI Number | 1982844460
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Entity Type | Individual
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Provider Name | SHELLEY MARIE MOORE NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 3368 HIGHWAY 280 SUITE 107
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City | ALEXANDER CITY
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State | AL
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Zip | 35010-3393
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Country | US
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Telephone | 256-212-9300
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Fax | 256-212-9363
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Provider Business Mailing Address
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Address Line | 1506 FIREHOUSE RD
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City | GOODWATER
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State | AL
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Zip | 35072-5733
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Country | US
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Telephone | 256-839-6087
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-074273
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License Number State | AL
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