Provider Demographics
NPI:1326191701
Name:MOORE, LAURA CAROLYN (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CAROLYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAROLYN
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7657
Mailing Address - Country:US
Mailing Address - Phone:817-702-2977
Mailing Address - Fax:817-702-2140
Practice Address - Street 1:401 STRIBLING DR STE 201
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2581
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-0241
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3045363LF0000X
COC-APN.0001358-C-NP363LF0000X
TXAP115665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS
TXPENDINGMedicaid
TXPENDINGMedicaid