Provider Demographics
NPI:1972043131
Name:MOORE, CANDICE DIANE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:DIANE
Last Name:MOORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4401 PARK SPRINGS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1899
Mailing Address - Country:US
Mailing Address - Phone:817-807-9060
Mailing Address - Fax:817-419-4505
Practice Address - Street 1:4401 PARK SPRINGS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1899
Practice Address - Country:US
Practice Address - Phone:817-807-9060
Practice Address - Fax:817-419-4505
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily