Provider Demographics
NPI:1154201499
Name:MORELAND, VICTOR BERNARD JR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:BERNARD
Last Name:MORELAND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 BUSBEE FLDS
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-0359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4239 BUSBEE FLDS
Practice Address - Street 2:
Practice Address - City:SAINT HEDWIG
Practice Address - State:TX
Practice Address - Zip Code:78152-0359
Practice Address - Country:US
Practice Address - Phone:913-206-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner