Amy Marie Moore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11886 Issued in TX

Practice address

3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504

Phone

(210) 916-8764

NPI assigned

Feb 6, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Amy Marie Shutt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: amoore66842@direct.utmsa.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1710259833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-8764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Cochrane Bld 7500",
            "address_2": "USA MEDDAC, Evans ACH",
            "address_purpose": "LOCATION",
            "city": "Ft. Carson",
            "state": "CO",
            "postal_code": "80913",
            "country_code": "US",
            "telephone_number": "210-247-7072",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2981 Garden Ave",
            "address_purpose": "LOCATION",
            "city": "Jbsa Ft Sam Houston",
            "state": "TX",
            "postal_code": "782347635",
            "country_code": "US",
            "telephone_number": "210-556-5147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "PA11886",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "SHUTT",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily S Minner
• Nicholas Lambert Molinelli, MD
• Matthew D Monaco, MD
• Dyese Moody
• Kimberly Lynn Megdanis Mooney, MD
• Bret Andrew Moore, PSY.D.
• Robert Moore, D.O.
• Tyler Moore, M.D.
• Nicholas Anthony Moran
• Griffin Andrew Morehead

• Physician Assistant in Jbsa Ft Sam Houston, TX
• Providers in Jbsa Ft Sam Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.

Verify at the official NPI Registry.