Individual
MARK BENTON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-4772
(704) 355-6227
Mailing address
PO BOX 601372, CHARLOTTE, NC 28260-1372
(704) 355-4772
(704) 355-6227
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
18527
TN
363LP0200X
Pediatric Nurse Practitioner
Primary
9700154
NC
363LP0200X
Pediatric Nurse Practitioner
ARNP 9219935
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005122
—
NC
05
—
NP1153
—
SC
Enumeration date
08/31/2006
Last updated
12/06/2021
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