Provider Demographics
NPI:1245748474
Name:MOORER, ERICA FAYE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:FAYE
Last Name:MOORER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:FAYE
Other - Last Name:GALLOWAY, JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1633 SORA WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3053
Mailing Address - Country:US
Mailing Address - Phone:623-202-2225
Mailing Address - Fax:
Practice Address - Street 1:1633 SORA WAY
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3053
Practice Address - Country:US
Practice Address - Phone:623-202-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-83376163W00000X
NMCNP-03494363LF0000X
TXAP137141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3818817Medicaid