MEDICARE: MISS LISA ANN MOORE ANP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	612461	TX

General Provider Information

NPI Number	:	1952619967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA ANN MOORE ANP-C

Provider Business Mailing Address
First Line	:	2705 W ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-795-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 W ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-795-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	08/09/2013

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