MEDICARE: MARIA MERCEDES REYES MORENO

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	1-185196	AL

General Provider Information

NPI Number	:	1578443016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MERCEDES REYES MORENO

Provider Business Mailing Address
First Line	:	223 DUSTIN LN NW
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35757-6972
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 DUSTIN LN NW
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35757-6972
Country	:	US
Telephone Number	:	256-503-9123
Fax Number	:

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

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	09/04/2025

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Directions to “ MARIA MERCEDES REYES MORENO ” Practice Location

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