Individual
MICHAEL JUSTIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
2610 N WOODLAWN BLVD, WICHITA, KS 67220-2729
(316) 858-2885
(316) 858-2530
Mailing address
2610 N WOODLAWN BLVD, WICHITA, KS 67220-2729
(316) 858-2885
(316) 858-2530
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
46060
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200536250C
—
KS
01
—
P00630601
RR MEDICARE
KS
Enumeration date
10/18/2007
Last updated
11/20/2008
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