MR. DERRICK MONTEREY MOORE NPI 1770739872

NPI Information

NPI: 1770739872
Provider Name: MR. DERRICK MONTEREY MOORE
Classification: Driver - 172A00000X
Entity Type: Individual
Address:
8325 POPLAR SPRINGS DR LOT 55
MERIDIAN, MS
ZIP 39305
Phone: (601) 681-4582
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MR. Derrick Monterey Moore is a driver in Meridian, MS. The provider is a person employed to operate a motor vehicle as a carrier of persons or property. MR. Derrick Monterey Moore NPI is 1770739872. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

8325 POPLAR SPRINGS DR LOT 55
MERIDIAN, MS
ZIP 39305-243
Phone: (601) 681-4582
Fax: (601) 681-9642

The enumeration date for this NPI number is 8/8/2008 and was last updated on 8/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	172A00000X	Driver		9205865	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02926254	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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