Provider Demographics
NPI:1952174344
Name:MORAN, PERI MCKENNA
Entity Type:Individual
Prefix:
First Name:PERI
Middle Name:MCKENNA
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 ALAMANDINE AVE
Mailing Address - Street 2:
Mailing Address - City:CROSS ROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5567
Mailing Address - Country:US
Mailing Address - Phone:214-912-4444
Mailing Address - Fax:
Practice Address - Street 1:1490 ALAMANDINE AVE
Practice Address - Street 2:
Practice Address - City:CROSS ROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-5567
Practice Address - Country:US
Practice Address - Phone:214-912-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily