Provider Demographics
NPI:1679154397
Name:RALSTON, CHEYNE LAYNE MOORE (FNP)
Entity Type:Individual
Prefix:
First Name:CHEYNE
Middle Name:LAYNE MOORE
Last Name:RALSTON
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 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-785-7685
Practice Address - Street 1:808 JOLIET AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1158
Practice Address - Country:US
Practice Address - Phone:806-761-0432
Practice Address - Fax:806-761-0433
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX913739163W00000X
TX1031866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse