Provider Demographics
NPI:1639988454
Name:MOELLERING, MADELINE LEIGH (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LEIGH
Last Name:MOELLERING
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2348
Mailing Address - Country:US
Mailing Address - Phone:903-279-9930
Mailing Address - Fax:
Practice Address - Street 1:11970 N CENTRAL EXPY STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3787
Practice Address - Country:US
Practice Address - Phone:972-942-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty