MEDICARE: NIKKIA MOORE CNA

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	376K00000X	Nurse's Aide	A00146638	MD

General Provider Information

NPI Number	:	1629453113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKIA MOORE CNA

Provider Business Mailing Address
First Line	:	1541 FORT DAVIS ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6025
Country	:	US
Telephone Number	:	202-423-6258
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 FORT DAVIS ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6025
Country	:	US
Telephone Number	:	202-423-6258
Fax Number	:

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

Provider Enumeration Date	:	07/25/2015
Last Update Date	:	07/25/2015

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Directions to “ NIKKIA MOORE CNA” Practice Location

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