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Individual

STEPHANIE L MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DIETITIAN

Contact information

Practice address
66 OLD AIRPORT RD, HATTIESBURG, MS 39401-8382
(601) 582-2619
(601) 544-4557
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 582-5461

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1108
MS

Other

Enumeration date
02/21/2008
Last updated
02/21/2008
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