Individual
FANTASIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2609 CARRINGTON LN, GRAND PRAIRIE, TX 75052-4005
(469) 264-1626
Mailing address
2609 CARRINGTON LN, GRAND PRAIRIE, TX 75052-4005
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
29101352
TX
Other
Enumeration date
03/12/2026
Last updated
03/12/2026
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