Provider Demographics
NPI:1477971489
Name:MOREAU, LEAH RENEE (AGACNP, RNFA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RENEE
Last Name:MOREAU
Suffix:
Gender:F
Credentials:AGACNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 METROPOLITAN DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2407
Mailing Address - Country:US
Mailing Address - Phone:409-833-2225
Mailing Address - Fax:
Practice Address - Street 1:6025 METROPOLITAN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2407
Practice Address - Country:US
Practice Address - Phone:409-833-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125459363LA2100X
TX768819163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant