Individual
CANDACE L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2650 N TENAYA WAY STE 301, LAS VEGAS, NV 89128
(702) 870-2099
(702) 869-5347
Mailing address
PO BOX 98978, LAS VEGAS, NV 89193-8978
(702) 870-2099
(702) 869-5347
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA940
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NV
Enumeration date
10/02/2006
Last updated
08/29/2018
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