Provider Demographics
NPI:1720816861
Name:MOORE, ALEXIS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5324 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8763
Mailing Address - Country:US
Mailing Address - Phone:432-557-6035
Mailing Address - Fax:
Practice Address - Street 1:3555 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7610
Practice Address - Country:US
Practice Address - Phone:325-747-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health