Individual
MICHAELA L. MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-9480
Mailing address
PO BOX 5392, MERIDIAN, MS 39302-5392
(601) 703-4379
(601) 703-9283
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
903902
MS
Other
Enumeration date
03/23/2020
Last updated
04/24/2020
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