Healthcare Provider Details

I. General information

NPI: 1447287925
Provider Name (Legal Business Name): JANICE MOORE GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 RANCH ROAD 2222 APT 3318
AUSTIN TX
78730-3228
US

IV. Provider business mailing address

1009 N GEORGETOWN ST
ROUND ROCK TX
78664-3289
US

V. Phone/Fax

Practice location:
  • Phone: 512-300-2455
  • Fax: 512-300-2454
Mailing address:
  • Phone: 512-255-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number238688
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number238688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: