Provider Demographics
NPI:1497583249
Name:MOORE, CIARA LYNNE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:LYNNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:CIARA
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10721 GRUB HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10721 GRUB HILL CHURCH RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4934
Practice Address - Country:US
Practice Address - Phone:804-921-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine