Provider Demographics
NPI:1093055188
Name:MOORE, MISTY JANE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:JANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:JANE
Other - Last Name:FINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 EVENING SHADOWS TRL
Mailing Address - Street 2:
Mailing Address - City:HOLLY LAKE RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75765-6346
Mailing Address - Country:US
Mailing Address - Phone:903-832-9566
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3347012367500000X
TXAP145429367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered