SHANE MOORE (NPI# 1417426529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417426529 |
| Entity Type | Individual |
| Full Name | SHANE MOORE |
| Practice Address |
7030 New Sanger Ave Ste 204 Waco TX 76712-4074 |
| Mailing Address |
Po Box 11538 Killeen TX 76547-1538 |
| Practice Telephone | 2542459175 |
| Practice Fax Number | 2542137771 |
| Mailing Telephone | 2542459177 |
| Mailing Fax Number | 2542459178 |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2020-10-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP139172 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | LICENSE | AP139172 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2304 Marketplace Dr, Waco, TX 767112467 | 2542027300 | 2542027350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982224796 | Shane Edward Moore | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-04-22 |
| 1518230747 | Shane Moore | Pharmacist | 2155 Lancaster Dr Ne, Salem, OR 97305-1228 | 2012-02-19 |
| 1639333669 | Shane D Moore IIi | Social Worker | 5707 N 22nd St, Tampa, FL 33610-4350 | 2008-07-18 |
| 1538233622 | Shane L Moore | Dentist | 2455 W Interstate 40, Amarillo, TX 79109-1852 | 2006-11-20 |
| Street Address |
7030 NEW SANGER AVE STE 204 |
| City | WACO |
| State | TX |
| Zip Code | 76712-4074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922634294 | Waco Ophthalmology, Pllc | Ophthalmology | 602 W Highway 6, Waco, TX 76712 | 2020-03-19 |
| 1326692872 | Oceans Behavioral Hospital of Waco LLC | Psychiatric Hospital | 5931 Crosslake Parkway, Waco, TX 76712 | 2019-08-01 |
| 1831759620 | Jessica Ngoc Vien | Optometrist | 1000 Hwy 6, Ste 210, Waco, TX 76712 | 2019-06-14 |
| 1780150888 | Chelsea Cannon | Occupational Therapist | 330 W State Hwy 6, Waco, TX 76712 | 2018-10-17 |
| 1669955399 | Elizabeth Ann Barnhill | Speech-Language Pathologist | 15003 Riatta Rd, Woodway, TX 76712 | 2018-09-09 |
| 1447731617 | Melanie A Melton | Physical Therapist | 300 West Highway 6, Waco, TX 76712 | 2018-08-27 |
| 1396226403 | Gala Kaye Czajkoski | Occupational Therapy Assistant | 300 West Hightway 6, Waco, TX 76712 | 2018-08-27 |
| 1619457454 | Monica Anderson | Physical Therapy Assistant | 300 W Hwy 6, Waco, TX 76712 | 2018-08-21 |
| 1295238368 | Waco Sn Opco LLC | Skilled Nursing Facility | 7501 Bagby, Waco, TX 76712 | 2018-03-14 |
| 1558872952 | C. Guy Fps, Pllc | Otolaryngology | 1129 Aberdeen Rd, Waco, TX 76712 | 2017-10-12 |
| Find all providers in zip 76712 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881209559 | Veronica House | Nurse Practitioner | 358 Flint Rd, Waco, KY 40385-9714 | 2020-09-10 |
| 1215409065 | Ashley Danielle Edmondson | Nurse Practitioner | 318 Richland West Cir Ste A, Waco, TX 76712-7919 | 2018-12-18 |
| 1588148290 | Catherine Paige Pollard | Nurse Practitioner | 120 Hillcrest Medical Blvd Ste 101, Waco, TX 76712-8949 | 2018-09-18 |
| 1578075081 | Ligia Liana Tofanel | Nurse Practitioner | 333 Londonderry Dr Ste 200, Waco, TX 76712-7930 | 2017-10-25 |
| 1114454410 | Joyce Belinda Ivie | Nurse Practitioner | 611 W Hwy 6 Ste 108, Waco, TX 76710-7545 | 2017-05-17 |
| 1700233004 | Kameron Harrison | Nurse Practitioner | 601 W Hwy 6 Ste 101, Waco, TX 76710-5592 | 2016-05-17 |
| 1508293705 | Katie A Carranza | Nurse Practitioner | 1800 Gurley Street, Waco, TX 76706-4025 | 2013-10-02 |
| 1710329859 | Rachel Paige Harrington | Nurse Practitioner | 4601 N. 19th Street, Bldg H, Waco, TX 76708-1261 | 2013-07-17 |
| 1255770970 | Michele Davis Groetzinger | Nurse Practitioner | 201 Westlane Cir, Waco, TX 76712-3186 | 2013-06-15 |
| 1760748180 | Elizabeth Antle Rushing | Nurse Practitioner | 4209 W Waco Dr Ste 6, Waco, TX 76710-7111 | 2012-04-10 |
| Find all providers in WACO | ||||
Please comment or provide details below to improve the information on SHANE MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.