Healthcare Provider Details

I. General information

NPI: 1841670056
Provider Name (Legal Business Name): HEATHER MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 EARNHARDT CIR
CABOT AR
72023-5047
US

IV. Provider business mailing address

73 EARNHARDT CIR
CABOT AR
72023-5047
US

V. Phone/Fax

Practice location:
  • Phone: 501-766-4167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR087145
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: