Provider Demographics
NPI:1043066855
Name:JULIA MOORE PMHNP
Entity type:Organization
Organization Name:JULIA MOORE PMHNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:540-449-2508
Mailing Address - Street 1:4210 ELECTRIC RD # 1092
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0728
Mailing Address - Country:US
Mailing Address - Phone:540-449-2508
Mailing Address - Fax:
Practice Address - Street 1:295 BIRDS NEST DR NW
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6114
Practice Address - Country:US
Practice Address - Phone:540-449-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty