Healthcare Provider Details

I. General information

NPI: 1215020920
Provider Name (Legal Business Name): VICKI HURLEY MOORE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MOUNT OLIVE ST SUITE 200
SILOAM SPRINGS AR
72761-3602
US

IV. Provider business mailing address

614 E EMMA AVE SUITE 300
SPRINGDALE AR
72764-4634
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-9550
  • Fax: 479-524-9552
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-751-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAO1821
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: