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General NPI Number Information
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NPI Number | 1073300927
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Entity Type | Individual
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Provider Name | DESIREE MOORE CCHW
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 409 S AMY LN APT D
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-1598
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Country | US
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Telephone | 254-338-8602
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Fax |
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Provider Business Mailing Address
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Address Line | 10 DAVOL SQ STE 100
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City | PROVIDENCE
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State | RI
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Zip | 02903-4752
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Country | US
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Telephone | 254-338-8602
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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