Provider Demographics
NPI:1699213140
Name:LUNA, MYRANDA DAYE (NP-C)
Entity type:Individual
Prefix:MS
First Name:MYRANDA
Middle Name:DAYE
Last Name:LUNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 N NOLAN RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-1250
Mailing Address - Country:US
Mailing Address - Phone:817-641-8800
Mailing Address - Fax:
Practice Address - Street 1:895 N NOLAN RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-1250
Practice Address - Country:US
Practice Address - Phone:817-641-8800
Practice Address - Fax:817-641-8807
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133166364SP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty