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Individual

CONI S MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1202 S TYLER ST, COVINGTON, LA 70433-2330
(985) 898-4438
Mailing address
78279 HIGHWAY 21, BUSH, LA 70431
(985) 630-8550

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
03968
LA
363LF0000X
Family Nurse Practitioner
Primary
03968
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03968
NURSE PRACTITIONERS
LA
Enumeration date
07/20/2006
Last updated
02/25/2021
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