Healthcare Provider Details

I. General information

NPI: 1437005683
Provider Name (Legal Business Name): MYA MOODY CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 COLONIAL DR
WEST MEMPHIS AR
72301-2546
US

IV. Provider business mailing address

1607 COLONIAL DR
WEST MEMPHIS AR
72301-2546
US

V. Phone/Fax

Practice location:
  • Phone: 870-225-3997
  • Fax:
Mailing address:
  • Phone: 870-225-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number7816
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: