Individual
MS. STACY RENEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C.
Contact information
Practice address
20370 ELM ST, HARRAH, OK 73045-9110
(405) 347-2109
(405) 454-6842
Mailing address
5670 HENNEY PL, CHOCTAW, OK 73020-9134
(405) 990-1199
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
427
OK
Other
Enumeration date
03/30/2007
Last updated
08/15/2014
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