Individual
MR. MARK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CFNP
Contact information
Practice address
1600 22ND AVE, MEDICAL TOWERS III, MERIDIAN, MS 39301-3223
(601) 483-5322
(601) 581-2289
Mailing address
1600 22ND AVE, MEDICAL TOWERS III, MERIDIAN, MS 39301-3223
(601) 483-5322
(601) 581-2289
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R669059
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02904207
—
MS
Enumeration date
12/27/2005
Last updated
06/02/2011
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