Provider Demographics
NPI:1417107905
Name:MOORE, JAMES DILLON (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DILLON
Last Name:MOORE
Suffix:
Gender:M
Credentials:FNP
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 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-626-1370
Mailing Address - Fax:940-393-0561
Practice Address - Street 1:133 N FM 730 UNIT 105
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023-3072
Practice Address - Country:US
Practice Address - Phone:940-433-2151
Practice Address - Fax:940-433-2366
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBSTX - WHS PS
TX8KB821OtherBCBSTX
TX336508207Medicaid
TXPENDINGMedicaid
TX75-2616977-001OtherTRICARE
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TXP01569239OtherRAIL ROAD MEIDCARE
TXPENDINGMedicaid
TX336508204Medicaid
TXPENIDNGOtherBCBSTX
TX336508202Medicaid
TXP01570034OtherRAIL ROAD MEDICARE