Provider Demographics
NPI:1053128579
Name:MOYER, DAVID SCOTT (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:MOYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1311 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-3523
Mailing Address - Country:US
Mailing Address - Phone:308-962-6398
Mailing Address - Fax:
Practice Address - Street 1:110 E E ST APT D
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2049
Practice Address - Country:US
Practice Address - Phone:308-962-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13249670373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist