Healthcare Provider Details

I. General information

NPI: 1649401266
Provider Name (Legal Business Name): SARAH KIMBERLY MOORE AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH KIMBERLY SLATTER

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 WHEATFIELD DR STE 100
SUNNYVALE TX
75182-4639
US

IV. Provider business mailing address

341 WHEATFIELD DR STE 100
SUNNYVALE TX
75182-4639
US

V. Phone/Fax

Practice location:
  • Phone: 972-285-0221
  • Fax: 972-285-0223
Mailing address:
  • Phone: 972-285-0221
  • Fax: 972-285-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP118238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: