Individual
MICHELLE DENISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
516B LINCOLN RD, COLUMBUS, MS 39705-2226
(662) 241-7177
(662) 241-7176
Mailing address
1700 CAL KOLOLA RD, CALEDONIA, MS 39740-9460
(662) 574-3894
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901781
MS
Other
Enumeration date
09/29/2016
Last updated
09/29/2016
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