1902055197 NPI number — MRS. NATALIE HERRINGTON MOORE CFNP

Table of content: MRS. NATALIE HERRINGTON MOORE CFNP (NPI 1902055197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902055197 NPI number — MRS. NATALIE HERRINGTON MOORE CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
NATALIE
Provider Middle Name:
HERRINGTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
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:
1902055197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 KEATING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38606-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-712-1460
Provider Business Mailing Address Fax Number:
662-563-0155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38606-8608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-712-2248
Provider Business Practice Location Address Fax Number:
662-712-2180
Provider Enumeration Date:
09/12/2008

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: 363LF0000X , with the licence number:  R865994 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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