MEDICARE: ANDREW THOMAS MOORE MSN, APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R195755	MD

General Provider Information

NPI Number	:	1073464061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW THOMAS MOORE MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	216 E PULASKI HWY STE 212
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-6589
Country	:	US
Telephone Number	:	302-384-7843
Fax Number	:	302-351-6427

Provider Business Practice Location Address
First Line	:	216 E PULASKI HWY STE 212
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-6589
Country	:	US
Telephone Number	:	302-384-7843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	05/29/2026

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