1518551019 NPI number — MRS. CASSANDRA DAWN MOORE MSN, APRN, NNP-BC

Table of content: MRS. CASSANDRA DAWN MOORE MSN, APRN, NNP-BC (NPI 1518551019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518551019 NPI number — MRS. CASSANDRA DAWN MOORE MSN, APRN, NNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
CASSANDRA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, NNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518551019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4104 S MERIDIAN GREENS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKINSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77539-8393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-392-3074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 ERWIN ROAD, HOCK PLAZA
Provider Second Line Business Practice Location Address:
SUITE #504
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-681-5551
Provider Business Practice Location Address Fax Number:
919-681-6065
Provider Enumeration Date:
02/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0005X , with the licence number:  5014114 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com