Individual
NOLA F. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1706 PROSPECT DR, MACON, MO 63552-2615
(660) 385-1006
(660) 385-1028
Mailing address
1706 PROSPECT DR, MACON, MO 63552-2615
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
132701
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00359523
RR MEDICARE
MO
Enumeration date
08/24/2006
Last updated
07/16/2019
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