Individual
COURTNEY L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4325 E CRICKET KNL, BLOOMINGTON, IN 47401-8103
(812) 345-7268
(317) 674-0060
Mailing address
4325 E CRICKET KNL, BLOOMINGTON, IN 47401-8103
(812) 345-7268
(317) 674-0060
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71007248A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71007248A
IN
Other
Enumeration date
07/18/2017
Last updated
03/08/2024
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