Provider Demographics
NPI:1134698780
Name:MORENO, YAMILY (PMHNP)
Entity Type:Individual
Prefix:
First Name:YAMILY
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:PMHNP
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 6696
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6696
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:361-985-1295
Practice Address - Street 1:6262 WEBER RD STE 120
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4030
Practice Address - Country:US
Practice Address - Phone:361-850-8300
Practice Address - Fax:361-850-8302
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health