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MS. BRANDI N MOORE PA
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1528041381
Individual Registrant:MS. BRANDI N MOORE PA
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
245 FORT CHISWELL RD STE D MAX MEADOWS, VA 24360-3987 US
Tel: 276-613-6991 Fax: --
Tel: 276-613-6991 Fax: --
Contact information for business:
1123 POWDER MILL RD IVANHOE, VA 24350-3559 US
Tel: 276-699-0105 Fax: --
Tel: 276-699-0105 Fax: --
Registration Information:
NPI: 1528041381
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | VA | 0110-002204 |
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | VA | 0110-002204 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 10220815 | VA | 05 | |
| 010220807 | VA | 05 | |
| NCCPA CERTIFICATE NUMBER | 1068476 | VA | 01 |
| 010220793 | VA | 05 |
