NPIMap

Organization Active NPI

Brenda K Moore DO PA

  • Clinic/Center
  • Niceville, FL
National Provider Identifier
1255733986
Registry record updated Sep 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
OS 12957 Issued in FL
Legal business name
BRENDA K MOORE DO PA
Practice address
1003 College Blvd W
Suite #2
Niceville, FL 32578-1068
Phone
(850) 678-0443
NPI assigned
Sep 25, 2014
Last updated
Sep 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda Kay Moore, DONPI 1275824120
Title
President
Phone
(832) 686-1965

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X OS 12957 FL Primary

Addresses

Primary practice location

1003 College Blvd W
Suite #2
Niceville, FL 32578-1068

Mailing address

1003 College Blvd W
Suite #2
Niceville, FL 32578-1068
Phone (850) 678-0443

National Provider Directory

National Provider Directory

Locations

1003 College Blvd W
Niceville, FL 32578
Phone (850) 678-0443

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411603200000",
    "number": "1255733986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 COLLEGE BLVD W",
            "address_2": "SUITE #2",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781068",
            "telephone_number": "850-678-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 COLLEGE BLVD W",
            "address_2": "SUITE #2",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781068",
            "telephone_number": "850-678-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENDA K MOORE DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-25",
        "last_updated": "2014-09-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "832-686-1965",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "OS 12957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.