Individual
DERONNA S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 W STONE DR STE 110, KINGSPORT, TN 37660-6027
(423) 224-3701
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110009681
VA
363A00000X
Physician Assistant
1903
KY
363A00000X
Physician Assistant
Primary
2543
TN
Other
Enumeration date
06/06/2014
Last updated
06/09/2025
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