Individual
SAMANTHA DARLENE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4334 BACK ST, KINGSTON, OK 73439-5350
(580) 565-0371
Mailing address
4334 BACK ST, KINGSTON, OK 73439-5350
(580) 565-0371
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/09/2012
Last updated
04/04/2014
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