Active NPI
Jessica Moore Wall
- Pharmacist
- Paris, TX
National Provider Identifier
1417555368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 67086
- Practice address
- 707 Lamar Ave Ste B
Paris, TX 75460-4460 - Phone
- (832) 969-5005
- NPI assigned
- Oct 13, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 67086 | TX | Primary |
Addresses
Primary practice location
707 Lamar Ave Ste B
Paris, TX 75460-4460
Mailing address
915 42ND St SE
Paris, TX 75462-8639
Phone (832) 969-5005
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 |
|---|---|---|---|
| 67086 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602547200000",
"number": "1417555368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 42ND ST SE",
"city": "PARIS",
"state": "TX",
"postal_code": "754628639",
"telephone_number": "832-969-5005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 LAMAR AVE STE B",
"city": "PARIS",
"state": "TX",
"postal_code": "754604460",
"telephone_number": "832-969-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE WALL",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-13",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "67086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paris, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.