Provider Demographics
NPI:1902055197
Name:MOORE, NATALIE HERRINGTON (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:HERRINGTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 KEATING RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2901
Mailing Address - Country:US
Mailing Address - Phone:662-712-1460
Mailing Address - Fax:662-563-0155
Practice Address - Street 1:303 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8608
Practice Address - Country:US
Practice Address - Phone:662-712-2248
Practice Address - Fax:662-712-2180
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily