Provider Demographics
NPI:1750754461
Name:MOYLE, JOHN (AGNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MOYLE
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-3228
Mailing Address - Country:US
Mailing Address - Phone:469-778-0017
Mailing Address - Fax:469-778-0019
Practice Address - Street 1:1619 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-3228
Practice Address - Country:US
Practice Address - Phone:469-778-0017
Practice Address - Fax:469-778-0019
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129244363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health