Individual
RAVEN TPRING MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
6175 NEWTON DR NE, COVINGTON, GA 30014-2690
(678) 342-6000
Mailing address
2878 FIVE FORKS TRICKUM RD, LAWRENCEVILLE, GA 30044-5896
(678) 344-8700
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
RN277339
GA
363L00000X
Nurse Practitioner
Primary
RN277339
GA
363LA2200X
Adult Health Nurse Practitioner
RN277339
GA
363LG0600X
Gerontology Nurse Practitioner
RN277339
GA
363LP2300X
Primary Care Nurse Practitioner
RN277339
GA
Other
Enumeration date
04/02/2021
Last updated
03/18/2024
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