Individual
MARIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 MINE LAKE CT STE 200, RALEIGH, NC 27615-6417
(520) 390-1793
Mailing address
122 E OAK ST, FORT MILL, SC 29715-1822
(678) 209-3046
(678) 209-3046
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-14553
NC
363AM0700X
Medical Physician Assistant
3876
TN
363AS0400X
Surgical Physician Assistant
3876
TN
Other
Enumeration date
06/20/2019
Last updated
04/09/2025
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