MEDICARE: MRS. RACHEL ANN MOORE PA-C

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	363AM0700X	Medical Physician Assistant	1709	OK

General Provider Information

NPI Number	:	1952573735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL ANN MOORE PA-C

Provider Business Mailing Address
First Line	:	9809 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6925
Country	:	US
Telephone Number	:	405-692-1557
Fax Number	:	405-692-4490

Provider Business Practice Location Address
First Line	:	9809 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6925
Country	:	US
Telephone Number	:	405-692-1557
Fax Number	:	405-692-4490

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	09/22/2009

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