Provider Demographics
NPI:1528898491
Name:MOORE, CHEVI BROOKE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:CHEVI
Middle Name:BROOKE LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:FOUKE
Mailing Address - State:AR
Mailing Address - Zip Code:71837-0041
Mailing Address - Country:US
Mailing Address - Phone:870-648-9300
Mailing Address - Fax:903-367-0300
Practice Address - Street 1:1600 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3518
Practice Address - Country:US
Practice Address - Phone:903-215-3149
Practice Address - Fax:903-367-0300
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR229994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily