Healthcare Provider Details

I. General information

NPI: 1003254574
Provider Name (Legal Business Name): JENNIFER ARCHER MOYLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PRESTON RD
PLANO TX
75024-3214
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 469-303-4700
  • Fax:
Mailing address:
  • Phone: 469-303-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: