Provider Demographics
NPI:1851855985
Name:MOORE, MIKA M'LAINE (APRN)
Entity type:Individual
Prefix:
First Name:MIKA
Middle Name:M'LAINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MIKA
Other - Middle Name:
Other - Last Name:LECHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3192
Mailing Address - Country:US
Mailing Address - Phone:936-290-0761
Mailing Address - Fax:936-666-4618
Practice Address - Street 1:123 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3192
Practice Address - Country:US
Practice Address - Phone:936-290-0761
Practice Address - Fax:936-666-4618
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily