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Individual
SHAWN WILLIAM MOORE
Active
Individual
SHAWN WILLIAM MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
RN191172
GA
363LF0000X
Family Nurse Practitioner
Primary
NP191172
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125809
—
GA
05
—
003125809A
—
GA
05
—
003125809B
—
GA
05
—
003125809F
—
GA
05
—
003125809G
—
GA
05
—
003125809I
—
GA
05
—
003125809J
—
GA
05
—
003125809K
—
GA
05
—
003125809L
—
GA
05
—
003125809Q
—
GA
01
—
01667286
AMERIGROUP
GA
Enumeration date
07/17/2012
Last updated
11/14/2025
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