Provider Demographics
NPI:1144912759
Name:MOORE, PHIARA JABRI (RNC)
Entity type:Individual
Prefix:MRS
First Name:PHIARA
Middle Name:JABRI
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COUNTRY GATE LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9204
Mailing Address - Country:US
Mailing Address - Phone:908-644-8100
Mailing Address - Fax:
Practice Address - Street 1:205 COUNTRY GATE LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9204
Practice Address - Country:US
Practice Address - Phone:908-644-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC254207163WP0808X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn