Provider Demographics
NPI:1578120986
Name:MOORE, HOLLY REITH (LVN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:REITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6006
Mailing Address - Country:US
Mailing Address - Phone:903-401-8958
Mailing Address - Fax:903-401-8145
Practice Address - Street 1:35 12TH ST SE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6006
Practice Address - Country:US
Practice Address - Phone:903-401-8958
Practice Address - Fax:903-401-8145
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse