Provider Demographics
NPI:1871826610
Name:MOORE, ELIZABETH J (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:MOORE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 OAK PARK COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1282
Mailing Address - Country:US
Mailing Address - Phone:774-285-0822
Mailing Address - Fax:765-966-1293
Practice Address - Street 1:10967 ALLISONVILLE RD STE 240
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2634
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28087121A2084P0800X
IN71005185B2084P0800X
IN71005185A2084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201258280Medicaid
IN000000899248OtherANTHEM
IN259370048Medicare PIN