MEDICARE: PRISCILA MOORES APRN

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	4704320224	MI
2	363LF0000X	Family Nurse Practitioner	000000	OK
3	363L00000X	Nurse Practitioner	97357	OK

General Provider Information

NPI Number	:	1639585045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILA MOORES APRN

Provider Business Mailing Address
First Line	:	16317 BRAVADO PL
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2207
Country	:	US
Telephone Number	:	405-361-2250
Fax Number	:	405-495-7825

Provider Business Practice Location Address
First Line	:	4510 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-2503
Country	:	US
Telephone Number	:	405-495-5841
Fax Number	:	405-495-7825

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	11/30/2021

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Directions to “ PRISCILA MOORES APRN” Practice Location

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