Provider Demographics
NPI:1457745788
Name:MOORE, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6404
Mailing Address - Country:US
Mailing Address - Phone:512-458-5323
Mailing Address - Fax:512-458-2030
Practice Address - Street 1:1600 W 38TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6404
Practice Address - Country:US
Practice Address - Phone:512-458-5323
Practice Address - Fax:512-458-2030
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127133363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359914401Medicaid
TX359914402Medicaid
TX359914404Medicaid
TX359914403Medicaid
TX359914402Medicaid
TX359914403Medicaid