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NPI Code Detail

MEDICARE: MRS. REBEKAH MOORE PMHNP

MEDICARE: MRS. REBEKAH MOORE PMHNP
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
1363LF0000XFamily Nurse Practitioner71004002AIN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner71004002AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144576232
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBEKAH MOORE PMHNP
Provider Business Mailing Address
First Line : 8003 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1946
Country : US
Telephone Number : 317-576-1335
Fax Number : 317-343-6562
Provider Business Practice Location Address
First Line : 2415 MITCHELL RD STE C
Second Line :
City : BEDFORD
State : IN
Zip : 47421-4747
Country : US
Telephone Number : 812-393-8070
Fax Number : 812-954-5024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2012
Last Update Date : 06/26/2025

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