Healthcare Provider Details

I. General information

NPI: 1730579921
Provider Name (Legal Business Name): EMILY MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 PINE ST
ARKADELPHIA AR
71923-5325
US

IV. Provider business mailing address

3004 PINE ST
ARKADELPHIA AR
71923-5325
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-2471
  • Fax: 870-246-2476
Mailing address:
  • Phone: 870-246-2471
  • Fax: 870-246-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR081681
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: