Individual
CHARLES K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2828 1ST AVE, SUITE 510, HUNTINGTON, WV 25702-1236
(304) 399-7533
(304) 399-7507
Mailing address
PO BOX 4190, BARBOURSVILLE, WV 25504-4190
(304) 399-4405
(304) 399-2526
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4411P
KY
363LF0000X
Family Nurse Practitioner
Primary
50644
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2654266
—
OH
05
—
3810004812
—
WV
05
—
7100008460
—
KY
01
—
P00892178
RR MEDICARE
WV
Enumeration date
03/01/2006
Last updated
04/22/2021
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