Individual
TIMOTHY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 RANDY HENDRIX DR, BATESVILLE, MS 38606-7664
(662) 563-9176
Mailing address
120 RANDY HENDRIX DR, BATESVILLE, MS 38606-7664
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R893379
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018204
—
MS
Enumeration date
12/15/2014
Last updated
12/15/2014
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