Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2017043285 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2021039037 | MO |
NPI | 1003577925 |
---|---|
Provider Name | Meghan Marie Moore |
First Address | Saint Louis, MO 63130-2314 |
Second Address | Creve Coeur, MO 63141-8252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |