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General NPI Number Information
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NPI Number | 1053283341
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Entity Type | Individual
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Provider Name | LYNNMARY TECKLER MOYO
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Gender | Female
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4941
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Country | US
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Telephone | 469-570-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W MAGNOLIA AVE STE 201
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City | FORT WORTH
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State | TX
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Zip | 76104-7657
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Country | US
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Telephone | 817-702-2977
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Fax | 817-702-2140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 1178464
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1178464
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License Number State | TX
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