Provider Demographics
NPI:1316482979
Name:MOORE, MANDY KARIMI (CRNA)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:KARIMI
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:KARIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2701 SHERRILL PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3217
Mailing Address - Country:US
Mailing Address - Phone:817-422-3958
Mailing Address - Fax:
Practice Address - Street 1:5055 W PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2586
Practice Address - Country:US
Practice Address - Phone:833-774-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered