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MS. BRANDI N MOORE PA

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1528041381

Individual Registrant:
MS. BRANDI N MOORE PA
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: --

Contact information for business:
1123 POWDER MILL RD  IVANHOE, VA 24350-3559 US
Tel: 276-699-0105  Fax: --

Registration Information:
NPI: 1528041381
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
VA0110-002204
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
VA0110-002204

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
10220815VA05
010220807VA05
NCCPA CERTIFICATE NUMBER1068476VA01
010220793VA05




HEALTH CARE JOBS VA - Page 1



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