Provider Demographics
NPI:1336620541
Name:MOPPIN, TIFFANY LEANNE (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEANNE
Last Name:MOPPIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 QUADE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2332
Mailing Address - Country:US
Mailing Address - Phone:913-515-3988
Mailing Address - Fax:
Practice Address - Street 1:10310 W GRAND PKWY S STE 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5924
Practice Address - Country:US
Practice Address - Phone:832-220-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX869506163WH0200X
TX1147550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome Health