Individual
TANTE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
504 AZALEA DR, SUITE A, OXFORD, MS 38655-5397
(662) 236-7738
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R884292
MS
Other
Enumeration date
11/03/2015
Last updated
10/18/2016
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