Provider Demographics
NPI:1982624029
Name:MOORE, KRISTY DAWN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DAWN
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 S HIGHWAY 377 STE 300
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-4331
Mailing Address - Country:US
Mailing Address - Phone:940-686-0860
Mailing Address - Fax:940-686-5834
Practice Address - Street 1:1246 S HIGHWAY 377 STE 300
Practice Address - Street 2:
Practice Address - City:PILOT POINT
Practice Address - State:TX
Practice Address - Zip Code:76258-4331
Practice Address - Country:US
Practice Address - Phone:940-686-0860
Practice Address - Fax:940-686-5834
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202135253OtherTAX