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Individual
TINA ANN WILKINSON MOORE
Active
Individual
TINA ANN WILKINSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03112
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196341501
—
TX
05
—
196341502
—
TX
01
—
8F9743
BCBS
TX
Enumeration date
09/15/2005
Last updated
01/28/2019
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