Provider Demographics
NPI:1649401266
Name:MOORE, SARAH KIMBERLY (AGNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KIMBERLY
Last Name:MOORE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KIMBERLY
Other - Last Name:SLATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:341 WHEATFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4639
Mailing Address - Country:US
Mailing Address - Phone:972-285-0221
Mailing Address - Fax:972-285-0223
Practice Address - Street 1:341 WHEATFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4639
Practice Address - Country:US
Practice Address - Phone:972-285-0221
Practice Address - Fax:972-285-0223
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118238363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner