Provider Demographics
NPI:1841422466
Name:MOORE, WENDY CATHERINE (DNP, APRN, RN)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CATHERINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, APRN, RN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:CATHERINE
Other - Last Name:PEAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 N HALL ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:214-820-1723
Mailing Address - Fax:
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:214-820-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684214163WC0200X
FLAPRN9429189364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine