Healthcare Provider Details

I. General information

NPI: 1295158103
Provider Name (Legal Business Name): KAITLIN ELIZABETH MOORE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 WALNUT HILL LN STE 220
DALLAS TX
75231-4425
US

IV. Provider business mailing address

8230 WALNUT HILL LN STE 220
DALLAS TX
75231-4425
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-8692
  • Fax:
Mailing address:
  • Phone: 214-345-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: