MEDICARE: ERICA FAYE MOORER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-83376	NM
2	363LF0000X	Family Nurse Practitioner	CNP-03494	NM
3	363LF0000X	Family Nurse Practitioner	AP137141	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245748474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA FAYE MOORER FNP-C

Provider Business Mailing Address
First Line	:	1633 SORA WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3053
Country	:	US
Telephone Number	:	623-202-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 SORA WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3053
Country	:	US
Telephone Number	:	623-202-2225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	07/21/2021

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