Active NPI
Halie Annette Moreno, PA-C, MPAS, MPH
- Physician Assistant
- Southlake, TX
National Provider Identifier
1093412256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16473
- Practice address
- 100 W Southlake Blvd Ste 420
Southlake, TX 76092-6166 - Phone
- (870) 918-2463
- NPI assigned
- Feb 8, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16473 | TX | Primary |
Addresses
Primary practice location
100 W Southlake Blvd Ste 420
Southlake, TX 76092-6166
Mailing address
301 Silveron Apt 8102
Flower Mound, TX 75028-4140
Phone (870) 918-2463
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 |
|---|---|---|---|
| PA16473 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675814400000",
"number": "1093412256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 SILVERON APT 8102",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "750284140",
"telephone_number": "870-918-2463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W SOUTHLAKE BLVD STE 420",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926166",
"telephone_number": "870-918-2463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "HALIE",
"middle_name": "ANNETTE",
"credential": "PA-C, MPAS, MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-08",
"last_updated": "2023-02-08",
"certification_date": "2023-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA16473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.