Healthcare Provider Details

I. General information

NPI: 1922807718
Provider Name (Legal Business Name): JULIA MICHELLE MOORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9545 N BEACH ST STE 101
FORT WORTH TX
76244-6470
US

IV. Provider business mailing address

2513 KATINA DR
FLOWER MOUND TX
75028-7581
US

V. Phone/Fax

Practice location:
  • Phone: 817-381-9650
  • Fax:
Mailing address:
  • Phone: 206-501-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1191370
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: