Individual provider Active NPI

Terria Moore, PA

  • Physician Assistant
  • Fort Eustis, VA
National Provider Identifier
1447456074
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
010002446 Issued in VA
Practice address
576 Jefferson Ave
Fort Eustis, VA 23604-1373
Phone
(757) 314-7602
Fax
(757) 314-7601
NPI assigned
Jun 21, 2007
Last updated
Apr 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 010002446 VA Primary
Physician Assistant 363A00000X 005591 GA

Addresses

Primary practice location

576 Jefferson Ave
Fort Eustis, VA 23604-1373

Mailing address

576 Jefferson Ave
Fort Eustis, VA 23604-1373
Phone (706) 562-4348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130510000014 VA Order and Referring Only - Physician Assistant 4486739505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
005591GAMDProfessional Counselor
010002446VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFHDD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776124800000",
    "number": "1447456074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373",
            "telephone_number": "706-562-4348",
            "fax_number": "757-314-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373",
            "telephone_number": "757-314-7602",
            "fax_number": "757-314-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TERRIA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "010002446",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005591",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Eustis, VA

Sources for this page

Verify at the official NPI Registry.