Individual
JONATHAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MEDICAL CTR. DRIVE, CLARKSBURG, WV 26301
(304) 623-3461
Mailing address
328 NEW ST, BRIDGEPORT, WV 26330-1417
(304) 918-4818
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN76344-FNP-BC
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN76344-FNP-BC
WV FNP-BC LICENSE NUMBER
WA
Enumeration date
11/20/2017
Last updated
11/20/2017
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