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Individual

TIMOTHY J MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1152 GREENVIEW RD, COLLIERVILLE, TN 38017-1160
(901) 674-4636
Mailing address
1152 GREENVIEW RD, COLLIERVILLE, TN 38017-1160
(901) 674-4636

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
36528
TN
367500000X
Certified Registered Nurse Anesthetist
901929
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q094735
TN
Enumeration date
02/28/2023
Last updated
06/30/2026
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