Provider Demographics
NPI:1235794777
Name:MOORE, LAUREN REBECCA
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:REBECCA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 CENTAURUS CT
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5025
Mailing Address - Country:US
Mailing Address - Phone:832-381-4505
Mailing Address - Fax:
Practice Address - Street 1:14900 CONSTELLATION CIR W
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5032
Practice Address - Country:US
Practice Address - Phone:832-381-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily