Individual
DANIEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
940 BROOKWAY BLVD, BROOKHAVEN, MS 39601-2644
(601) 823-5000
(601) 823-4140
Mailing address
940 BROOKWAY BLVD, BROOKHAVEN, MS 39601-2644
(601) 823-5000
(601) 823-4140
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
892107
MS
363LF0000X
Family Nurse Practitioner
Primary
902196
MS
Other
Enumeration date
05/12/2017
Last updated
03/17/2018
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