Individual
MRS. AMY MICHELLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
658702
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049KE
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/10/2006
Last updated
09/20/2011
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