Individual
MIRANDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1050 REID PKWY STE 100, RICHMOND, IN 47374-1156
(765) 935-8454
(765) 935-8453
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICE, RICHMOND, IN 47374-1157
(765) 935-5331
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1000372A
IN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/29/2014
Last updated
05/17/2021
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