Provider Demographics
NPI:1093412256
Name:MORENO, HALIE ANNETTE (PA-C, MPAS, MPH)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:ANNETTE
Last Name:MORENO
Suffix:
Gender:F
Credentials:PA-C, MPAS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:301 SILVERON APT 8102
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4140
Mailing Address - Country:US
Mailing Address - Phone:870-918-2463
Mailing Address - Fax:
Practice Address - Street 1:100 W SOUTHLAKE BLVD STE 420
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6166
Practice Address - Country:US
Practice Address - Phone:870-918-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant