Provider Demographics
NPI:1871574459
Name:MOORE, PATRICIA D
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WETUPKA WAY
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-4420
Mailing Address - Country:US
Mailing Address - Phone:662-429-5835
Mailing Address - Fax:662-449-0443
Practice Address - Street 1:11301 WETUPKA WAY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-4420
Practice Address - Country:US
Practice Address - Phone:662-429-5835
Practice Address - Fax:662-449-0443
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist