Provider Demographics
NPI:1871810812
Name:MOORE, MONICA A (FNP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD STE B329
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6756
Mailing Address - Country:US
Mailing Address - Phone:251-660-3510
Mailing Address - Fax:251-660-3511
Practice Address - Street 1:6701 AIRPORT BLVD STE B329
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6756
Practice Address - Country:US
Practice Address - Phone:251-660-3510
Practice Address - Fax:251-660-3511
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072334363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-06330OtherBLUE CROSS OF AL
AL122011Medicaid
AL102I508169Medicare PIN