Provider Demographics
NPI:1326517509
Name:MOORE, CAMETT MICHELLE
Entity Type:Individual
Prefix:
First Name:CAMETT
Middle Name:MICHELLE
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 1:1130 COTTONWOOD CREEK TRL STE B1
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7862
Mailing Address - Country:US
Mailing Address - Phone:512-986-7537
Mailing Address - Fax:512-986-7540
Practice Address - Street 1:8103 BRODIE LN STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7475
Practice Address - Country:US
Practice Address - Phone:512-502-5019
Practice Address - Fax:737-249-9246
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health