Provider Demographics
NPI:1922687037
Name:MOORE, TIERNI ANN (MD)
Entity type:Individual
Prefix:
First Name:TIERNI
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 RED COACH DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1297
Mailing Address - Country:US
Mailing Address - Phone:937-399-3010
Mailing Address - Fax:937-399-3020
Practice Address - Street 1:280 RED COACH DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1297
Practice Address - Country:US
Practice Address - Phone:937-399-3010
Practice Address - Fax:937-399-3020
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35149482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program