Individual
TYLER HERCHELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
37 S 2ND E STE 101, REXBURG, ID 83440-1906
(208) 356-0234
Mailing address
37 S 2ND E, REXBURG, ID 83440-1906
(208) 356-0234
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
72632
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72632
STATE BOARD OF NURSING
ID
Enumeration date
05/10/2022
Last updated
05/10/2022
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