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General NPI Number Information
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NPI Number | 1922999598
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Entity Type | Individual
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Provider Name | SHAYLEE NICKOLE MORENO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 26631 US HIGHWAY 380 E STE A
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City | PROVIDENCE VILLAGE
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State | TX
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Zip | 76227-3803
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Country | US
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Telephone | 940-686-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 26631 US HIGHWAY 380 E STE A
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City | PROVIDENCE VILLAGE
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State | TX
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Zip | 76227-3803
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Country | US
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Telephone | 940-686-7500
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1010617
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License Number State | TX
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