Provider Demographics
NPI:1386672533
Name:MOORE, MARGIE (CPNP)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3425
Mailing Address - Country:US
Mailing Address - Phone:361-991-1885
Mailing Address - Fax:361-991-1839
Practice Address - Street 1:6434 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3425
Practice Address - Country:US
Practice Address - Phone:361-991-1885
Practice Address - Fax:361-991-1839
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508421363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics