Individual
GALE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.M.
Contact information
Practice address
1401 OAK ST, GRENADA, MS 38901-4633
(662) 226-4010
(662) 226-4495
Mailing address
1401 OAK ST, GRENADA, MS 38901-4633
(662) 226-4010
(662) 226-4495
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
R525294
MS
367A00000X
Advanced Practice Midwife
Primary
R525294
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111153
—
MS
Enumeration date
10/17/2006
Last updated
01/04/2012
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