Individual
MEGAN J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S; RD
Contact information
Practice address
209 W SPRING ST, SUITE 300, SYLACAUGA, AL 35150-2973
(256) 208-0060
(255) 208-0755
Mailing address
209 W SPRING ST, SUITE 300, SYLACAUGA, AL 35150-2973
(256) 208-0060
(256) 208-0755
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1913
AL
363AM0700X
Medical Physician Assistant
Primary
PA.882
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165866
—
AL
01
—
1913
AL BOARD DIET/NUT
AL
01
—
989061
CDR
AL
01
—
PA.882
NCCPA
AL
Enumeration date
04/14/2008
Last updated
08/09/2016
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