Healthcare Provider Details

I. General information

NPI: 1265346415
Provider Name (Legal Business Name): PATRAL MOSES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 HIGHWAY 5 N APT 2309
BENTON AR
72019-6750
US

IV. Provider business mailing address

1907 HIGHWAY 5 N APT 2309
BENTON AR
72019-6750
US

V. Phone/Fax

Practice location:
  • Phone: 870-740-3240
  • Fax:
Mailing address:
  • Phone: 870-740-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: