MEDICARE: ELIZABETH MOORE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	221593	AR

General Provider Information

NPI Number	:	1538937339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MOORE APRN

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:	870-301-2092

Provider Business Practice Location Address
First Line	:	3150 E HERITAGE PKWY
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-5529
Country	:	US
Telephone Number	:	479-400-1140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/15/2023

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Directions to “ ELIZABETH MOORE APRN” Practice Location

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