Individual
JANICE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
7201 RANCH ROAD, 2222 APT 3318, AUSTIN, TX 78730-3228
(512) 300-2455
(512) 300-2454
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
238688
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
238688
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141123302
—
TX
01
—
8N7149
BCBS PROVIDER#
TX
01
—
A008
WPS TRICARE PROVIDER#
TX
Enumeration date
06/28/2006
Last updated
12/04/2014
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