Healthcare Provider Details

I. General information

NPI: 1588096044
Provider Name (Legal Business Name): MICHELLE ANNETTE MORAN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WEST 2ND STREET
LONOKE AR
72086-2804
US

IV. Provider business mailing address

215 E 9TH ST
CARLISLE AR
72024-9382
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-3151
  • Fax: 501-676-3152
Mailing address:
  • Phone: 870-659-7002
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: