Provider Demographics
NPI:1831199272
Name:MOORE, TERESA REAMES (PA-C)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:REAMES
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:236 MEADOWCREEK
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8272
Mailing Address - Country:US
Mailing Address - Phone:972-771-2726
Mailing Address - Fax:214-590-4162
Practice Address - Street 1:VA NORTH TEXAS HEALTH CARE SYSTEM
Practice Address - Street 2:4500 SOUTH LANCASTER RD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-1558
Practice Address - Fax:214-302-1433
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS82287Medicare UPIN
TX8B5034Medicare ID - Type UnspecifiedD62C