Healthcare Provider Details

I. General information

NPI: 1497420608
Provider Name (Legal Business Name): MOESHA GAYNELL LIVINGSTON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 07/21/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 HAWKINS DR
SEARCY AR
72143
US

IV. Provider business mailing address

2103 W. REPUBLICAN
JACKSONVILLE AR
72076
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-9255
  • Fax:
Mailing address:
  • Phone: 870-308-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: