Provider Demographics
NPI:1912066440
Name:MOORE, SHIRLEY K (ACA, BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4131
Mailing Address - Country:US
Mailing Address - Phone:806-355-8889
Mailing Address - Fax:
Practice Address - Street 1:5501 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4131
Practice Address - Country:US
Practice Address - Phone:806-355-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50132237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist