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NPI Code Detail

MEDICARE: MR. NATHAN MOORE APRN-C

MEDICARE: MR. NATHAN MOORE APRN-C
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 Practitioner2021013225MO
2363LP2300XPrimary Care Nurse PractitionerARNP9367810FL

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 : 1154846442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN MOORE APRN-C
Provider Business Mailing Address
First Line : 7334 S LINDBERGH BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63125-4522
Country : US
Telephone Number : 314-892-8352
Fax Number :
Provider Business Practice Location Address
First Line : 7334 S LINDBERGH BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63125-4522
Country : US
Telephone Number : 314-892-8352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 05/27/2021

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