Individual
LASTESHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5543 EDMONDSON PIKE, SUITE 106, NASHVILLE, TN 37211
(479) 601-7700
(615) 523-2900
Mailing address
5543 EDMONDSON PIKE STE 106, NASHVILLE, TN 37211-5808
(479) 601-7700
(615) 523-2900
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93939393
NA
—
Enumeration date
02/19/2021
Last updated
02/19/2021
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