MEDICARE: CHARLESZETTA MOORE QMHP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator	TX
2	171W00000X	Contractor	TX
3	172V00000X	Community Health Worker	TX
4	372600000X	Adult Companion	TX
5	373H00000X	Day Training/Habilitation Specialist	TX
6	251B00000X	Case Management Agency	TX

General Provider Information

NPI Number	:	1487361341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLESZETTA MOORE QMHP

Provider Business Mailing Address
First Line	:	5125 WICHITA ST UNIT 15407
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-2501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 DISRAELI DR APT 5101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-5851
Country	:	US
Telephone Number	:	817-585-0664
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

Similar Medicare Providers

1730120908 — LEGACY HEART CARE OF FORT WORTH, LLC
Practice Location Address:

2500 WEST FWY STE 200
FORT WORTH, TX
76102-5851

Practice Phone: 817-423-4400
Practice Fax: 817-423-8080

1780223289 — DAWN RAINER APRN-BC
Practice Location Address:

2500 WEST FWY STE 200
FORT WORTH, TX
76102-5851

Practice Phone: 817-423-4400
Practice Fax:

1649098831 — FT NETWORK LLC
Practice Location Address:

2500 WEST FWY STE 200
FORT WORTH, TX
76102-5851

Practice Phone: 817-423-4400
Practice Fax: 817-423-8080

1457415226 — MRS. AMY S. LEE M.A., C.C.C.
Practice Location Address:

4328 ROCHARD LN
FORT MILL, SC
29707-5851

Practice Phone: 530-518-8248
Practice Fax:

1033558614 — HEAVENLY HELPERS SERVICES
Practice Location Address:

5851 JEFFREY LN
FORT MYERS, FL
33907-7800

Practice Phone: 239-246-2858
Practice Fax: 239-313-5464

1679061014 — JAMIE SALSBERG LCSW, CAP
Practice Location Address:

5851 LA GORCE CIR
LAKE WORTH, FL
33463-7376

Practice Phone: 917-796-6854
Practice Fax:

Directions to “ CHARLESZETTA MOORE QMHP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.