Provider Demographics
NPI:1093732687
Name:MOORE, SYLVIA KAYE (WHNP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:KAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORTH WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-924-5144
Practice Address - Street 1:1250 8TH AVENUE, SUITE 435
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-923-0088
Practice Address - Fax:817-924-5144
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00055216OtherRAILROAD
TX159560501Medicaid
TX159560501Medicaid
TX8A9268Medicare PIN