MEDICARE: DEANNA MOORE FNP

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	363LF0000X	Family Nurse Practitioner	F03190439	NC

General Provider Information

NPI Number	:	1447804752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA MOORE FNP

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:	205-545-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 WESTERN BLVD
Second Line	:
City	:	TARBORO
State	:	NC
Zip	:	27886-4858
Country	:	US
Telephone Number	:	252-774-4250
Fax Number	:

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

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	11/15/2023

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