Healthcare Provider Details

I. General information

NPI: 1154201499
Provider Name (Legal Business Name): VICTOR BERNARD MORELAND JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 BUSBEE FLDS
SAINT HEDWIG TX
78152-0359
US

IV. Provider business mailing address

4239 BUSBEE FLDS
SAINT HEDWIG TX
78152-0359
US

V. Phone/Fax

Practice location:
  • Phone: 913-206-0039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1035715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: