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General NPI Number Information
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NPI Number | 1235948456
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Entity Type | Individual
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Provider Name | JOHNNY CLIFTON MOORE
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Gender | Male
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 860 HEBRON PKWY STE 1101
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City | LEWISVILLE
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State | TX
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Zip | 75057-5147
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Country | US
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Telephone | 469-444-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 4705 CLEVES AVE
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City | AUBREY
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State | TX
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Zip | 76227-1881
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Country | US
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Telephone | 693-200-0007
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1184125
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License Number State | TX
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