Healthcare Provider Details

I. General information

NPI: 1558146837
Provider Name (Legal Business Name): JESSICA MORENO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 HORIZON RD STE 104
HEATH TX
75032-2103
US

IV. Provider business mailing address

6780 HORIZON RD STE 104 STE 104
HEATH TX
75032-2104
US

V. Phone/Fax

Practice location:
  • Phone: 469-887-1802
  • Fax:
Mailing address:
  • Phone: 469-887-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1081657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: