Healthcare Provider Details

I. General information

NPI: 1336620541
Provider Name (Legal Business Name): TIFFANY LEANNE MOPPIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 01/03/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W GRAND PKWY S STE 203
RICHMOND TX
77406-5924
US

IV. Provider business mailing address

7935 QUADE CT
RICHMOND TX
77469-2332
US

V. Phone/Fax

Practice location:
  • Phone: 832-220-2338
  • Fax:
Mailing address:
  • Phone: 913-515-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number869506
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1147550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: