Provider Demographics
NPI:1447287925
Name:MOORE, JANICE (GNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3289
Mailing Address - Country:US
Mailing Address - Phone:512-255-1720
Mailing Address - Fax:
Practice Address - Street 1:7201 RANCH ROAD
Practice Address - Street 2:2222 APT 3318
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-3228
Practice Address - Country:US
Practice Address - Phone:512-300-2455
Practice Address - Fax:512-300-2454
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238688363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA008OtherWPS TRICARE PROVIDER#
TX8N7149OtherBCBS PROVIDER#
TX141123302Medicaid
TX8N7149OtherBCBS PROVIDER#
TX8B6361Medicare ID - Type UnspecifiedMCARE PROVIDER#
TX141123302Medicaid