Healthcare Provider Details

I. General information

NPI: 1184555377
Provider Name (Legal Business Name): AMANDA LEE MOORE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD STE 180
PASADENA CA
91101-6144
US

IV. Provider business mailing address

2829 WATT AVE STE 200
SACRAMENTO CA
95821-6245
US

V. Phone/Fax

Practice location:
  • Phone: 916-252-3677
  • Fax:
Mailing address:
  • Phone: 916-418-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number95254874
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: