MEDICARE: JANICE MARIE MOORE ARNP

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	363L00000X	Nurse Practitioner	N3097006	OK
2	363L00000X	Nurse Practitioner	R0053173	OK
3	363L00000X	Nurse Practitioner	2013042559	MO
4	363L00000X	Nurse Practitioner	536444	TX
5	363L00000X	Nurse Practitioner	AP125297	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1588653307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE MARIE MOORE ARNP

Provider Business Mailing Address
First Line	:	PO BOX 996
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-0996
Country	:	US
Telephone Number	:	405-226-0163
Fax Number	:

Provider Business Practice Location Address
First Line	:	9205 STANTON L YOUNG BLVD, WP2430
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3251
Country	:	US
Telephone Number	:	405-271-7449
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/25/2016

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Directions to “ JANICE MARIE MOORE ARNP” Practice Location

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