Moore, Elethia M

Moore, Elethia M is an individual health care provider with primary practice located at 310 Old Ivy Way , Charlottesville VA 22903-4896. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Moore, Elethia M can be contacted via phone (434) 243-6950.

Contact Information

Primary practice address
310 Old Ivy Way Charlottesville VA 22903-4896
Phone: (434) 243-6950
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 0024189825 Virginia

Profile Details

NPI number 1114402427
LBN Legal business name Moore, Elethia M
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2018
Last updated Aug 19th, 2026 - about 3 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114402427 NPPES
Virginia MEDICAID 1336293000

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