Individual
ELETHIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 768-7318
Mailing address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 768-7318
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024189825
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336293000
—
VA
Enumeration date
10/02/2018
Last updated
05/03/2024
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