Individual
CARRIE LEIGH MOOTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
Mailing address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP114573
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160925001
—
AR
05
—
1689634586
—
TX
05
—
195775503
—
TX
01
—
5Y808
BCBS
AR
01
—
667523
MEDICARE
TX
01
—
8JM981
BCBS
TX
01
—
P00315041
RR MEDICARE GROUP CK6327
—
01
—
P02057009
MEDICARE RAIL ROAD
TX
Enumeration date
03/24/2006
Last updated
01/31/2024
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