Provider Demographics
NPI:1477341949
Name:MORA, SOPHIA BECKETT (PA-C)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:BECKETT
Last Name:MORA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N ROARING SPRINGS RD APT 3304
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3532
Mailing Address - Country:US
Mailing Address - Phone:505-710-5645
Mailing Address - Fax:
Practice Address - Street 1:6844 HARRIS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4281
Practice Address - Country:US
Practice Address - Phone:817-263-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant