MARK BENTON MOORE ARNP NPI 1205948981

NPI Information

NPI: 1205948981
Provider Name: MARK BENTON MOORE, ARNP
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
1000 BLYTHE BLVD
CHARLOTTE, NC
ZIP 28203
Phone: (704) 355-4772
Get Directions

Mark Benton Moore, ARNP is a pediatrics nurse practitioner in Charlotte, NC. Mark Benton Moore, ARNP NPI is 1205948981. 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:

1000 BLYTHE BLVD
CHARLOTTE, NC
ZIP 28203-812
Phone: (704) 355-4772
Fax: (704) 355-6227

The NPI 1205948981 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/31/2006 and was last updated on 12/6/2021.

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	363L00000X	Nurse Practitioner		18527	TENNESSEE	No
2	363LP0200X	Nurse Practitioner	Pediatrics	ARNP 9219935	FLORIDA	No
3	363LP0200X	Nurse Practitioner	Pediatrics	9700154	NORTH CAROLINA	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	NP1153	MEDICAID	SOUTH CAROLINA
2	7005122	MEDICAID	NORTH CAROLINA

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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