Provider Demographics
NPI:1891303947
Name:MOORE, CHASSIE NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:CHASSIE
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 FAR WEST BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3081
Mailing Address - Country:US
Mailing Address - Phone:512-828-3990
Mailing Address - Fax:512-241-1277
Practice Address - Street 1:3508 FAR WEST BLVD STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3081
Practice Address - Country:US
Practice Address - Phone:512-828-3990
Practice Address - Fax:512-241-1277
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGPRN243838163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics