MEDICARE: NICOLE LOUISE MOORE

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1982537163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LOUISE MOORE

Provider Business Mailing Address
First Line	:	1712 GATEWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 W CHEYENNE AVE STE 10
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-3931
Country	:	US
Telephone Number	:	702-633-5096
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ NICOLE LOUISE MOORE ” Practice Location

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