Healthcare Provider Details

I. General information

NPI: 1457745788
Provider Name (Legal Business Name): ERIN MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 38TH ST STE 100
AUSTIN TX
78731-6404
US

IV. Provider business mailing address

1600 W 38TH ST STE 100
AUSTIN TX
78731-6404
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-5323
  • Fax: 512-458-2030
Mailing address:
  • Phone: 512-458-5323
  • Fax: 512-458-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-318517
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP127133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: