Healthcare Provider Details

I. General information

NPI: 1831199272
Provider Name (Legal Business Name): TERESA REAMES MOORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA ANNE MOORE PA-C

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA NORTH TEXAS HEALTH CARE SYSTEM 4500 SOUTH LANCASTER RD
DALLAS TX
75216
US

IV. Provider business mailing address

236 MEADOWCREEK
ROCKWALL TX
75032-8272
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1558
  • Fax: 214-302-1433
Mailing address:
  • Phone: 972-771-2726
  • Fax: 214-590-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: