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Individual
ANNETTE RENE MOORE
Active
Individual
ANNETTE RENE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
71000750A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042207
ANTHEM BCBS
IN
05
—
100473980
—
IN
01
—
1161025
PASSPORT KY MEDICAID
KY
01
—
2439492000
PASSPORT ADVANTAGE
KY
01
—
500012166
MEDICARE RAILROAD
—
01
—
5012042
AETNA
—
01
—
709911P
SIHO
IN
05
—
78007887
—
KY
Enumeration date
07/07/2006
Last updated
11/27/2023
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