Moore, Mary

Moore, Mary is an individual health care provider with primary practice located at 1980 Holton Ave E , Big Stone Gap VA 24219-3366. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Moore, Mary can be contacted via phone (276) 523-3111.

Contact Information

Primary practice address
1980 Holton Ave E Big Stone Gap VA 24219-3366
Phone: (276) 523-3111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0024049167 Virginia

Profile Details

NPI number 1912010166
LBN Legal business name Moore, Mary
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2006
Last updated Nov 29th, 2007 - about 19 years 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 1912010166 NPPES
Kentucky MEDICAID 74012436

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