Provider Demographics
NPI:1770643843
Name:MOORE, ALLISON L (MSN)
Entity Type:Individual
Prefix:PROF
First Name:ALLISON
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 860
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:214-820-8500
Mailing Address - Fax:214-820-8168
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 860
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-8500
Practice Address - Fax:214-820-8168
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661224363L00000X, 363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184842605Medicaid
TX184842604Medicaid
TXTXB144290Medicare PIN
TX184842605Medicaid