Healthcare Provider Details

I. General information

NPI: 1134805377
Provider Name (Legal Business Name): BRITTANI MOFFETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPRINGHILL RD STE 200
BRYANT AR
72019-7566
US

IV. Provider business mailing address

3922 RIMROCK DR
BENTON AR
72019-8089
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2500
  • Fax: 501-943-3016
Mailing address:
  • Phone: 870-917-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223970
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: