Jennifer Renae Moore
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Borger, TX
NPI 1083409502 · NPPES record last updated Aug 5, 2025
Key facts
- NPI
- 1083409502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 1186147 (TX)
- Practice address
- 120 Avalon St
Borger, TX 79007-8303 - Phone
- (806) 886-0177
- NPI assigned
- Apr 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2501 Lakeview Dr
Amarillo, TX 79109-1531
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250720000095 | TX | Practitioner - Nurse Practitioner | 8628584489 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP1186147 | TX | MD | Nurse Practitioner |
| 1186147 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FMC Medical Foundation, Inc. | Current |
Accepting new patients | |
| Castro County Hospital District | Current | Accepting new patients |
Locations
2501 Lakeview Dr
Amarillo, TX 79109
Phone (806) 350-7325
1500 S Coulter St
Ste 3
Amarillo, TX 79106
Phone (806) 350-7601
2329 Ross Osage St
Amarillo, TX 79103
Phone (806) 350-5790
911 23rd St
#0
Canyon, TX 79015
310 W Halsell St
Dimmitt, TX 79027
Phone (806) 647-2191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP1186147 | TX | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1186147 | TX | Yes |
Addresses
Primary practice location
120 Avalon St
Borger, TX 79007-8303
Mailing address
120 Avalon St
Borger, TX 79007-8303
Phone (806) 886-0177
Other practice location 1
1500 S Coulter St Ste 3
Amarillo, TX 79106-1787
Phone (806) 350-7601
Other providers in Borger, TX
- Maxwell Chiropractic Services, P.a.
- Jamey Ray Maxwell
- Vicente F Maza
- Holly Ann McKee
- Mona Agarwal Dentistry PLLC
- William Ray Myers II
- Tami Lynn Newman
- NWTX Physician Network, PLLC
- NWTX Physician Network, PLLC
- NWTX Physician Network, PLLC
All providers in Borger, TX · Psychiatric/Mental Health Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.