MRS. AMANDA MICHELE MOORE, NP-C - NPI NUMBER 1063769719

Summary

Provider Name: MRS. AMANDA MICHELE MOORE, NP-C

NPI Number: 1063769719

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Organization: SAMINA YOUSUF MD PC

Address:
142 HIGHLAND DR
LEBANON, VA
ZIP 24266

Phone Number: (276) 889-0433



Detailed Information

MRS. Amanda Michele Moore, NP-C is a family nurse practitioner in Lebanon, VA with 2 years of experience. The assigned NPI number for this provider is 1063769719 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
Graduation Year: 2012

The provider's business address is:

142 HIGHLAND DR
LEBANON, VA
ZIP 24266-636
Phone: (276) 889-0433
Fax: (276) 889-5537

The enumeration date for this NPI number is 8/13/2012 and was last updated on 5/13/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363LF0000X Nurse Practitioner Family 0024170245 VA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 20-4022083 OTHER VA EMPLOYER IDENTIFICATION NUMBER

NPI Record

No. Field Name Field Value
1 NPI 1063769719
2 Entity Type Code 1
3 Provider Last Name Legal Name MOORE
4 Provider First Name AMANDA
5 Provider Middle Name MICHELE
6 Provider Name Prefix Text MRS.
7 Provider Credential Text NP-C
8 Provider First Line Business Practice Location Address 142 HIGHLAND DR
9 Provider Business Practice Location Address City Name LEBANON
10 Provider Business Practice Location Address State Name VA
11 Provider Business Practice Location Address Postal Code 242664636
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2768890433
14 Provider Business Practice Location Address Fax Number 2768895537
15 Provider Enumeration Date 8/13/2012
16 Last Update Date 5/13/2013
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 363LF0000X
19 Provider License Number 1 0024170245
20 Provider License Number State Code 1 VA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 20-4022083
23 Other Provider Identifier Type Code 1 01
24 Other Provider Identifier State 1 VA
25 Other Provider Identifier Issuer 1 EMPLOYER IDENTIFICATION NUMBER
26 Is Sole Proprietor N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.