Active NPI
Joan Pauline Moulton, ATC, LAT
- Athletic Trainer
- Plano, TX
National Provider Identifier
1063625564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 2200 Independence Pkwy
Plano, TX 75075-3143 - Phone
- (469) 752-9518
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | TX | Primary |
Addresses
Primary practice location
2200 Independence Pkwy
Plano, TX 75075-3143
Mailing address
18665 Midway Rd Apt 1912
Dallas, TX 75287-3951
Phone (972) 977-6856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 050102050 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063625564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18665 MIDWAY RD APT 1912",
"city": "DALLAS",
"state": "TX",
"postal_code": "752873951",
"telephone_number": "972-977-6856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 INDEPENDENCE PKWY",
"city": "PLANO",
"state": "TX",
"postal_code": "750753143",
"telephone_number": "469-752-9518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTON",
"first_name": "JOAN",
"middle_name": "PAULINE",
"name_prefix": "Mrs.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.