Provider Demographics
NPI:1497065619
Name:MOORE, AMANDA D (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8312
Mailing Address - Country:US
Mailing Address - Phone:806-743-2373
Mailing Address - Fax:806-743-2399
Practice Address - Street 1:113 WALNUT ST
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329-4003
Practice Address - Country:US
Practice Address - Phone:806-892-2537
Practice Address - Fax:806-892-2726
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709372363LF0000X
TXAP119568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily