Healthcare Provider Details

I. General information

NPI: 1184163537
Provider Name (Legal Business Name): MS. RHONDA MOFFETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E RIVER PL STE 100
JACKSON MS
39202-3442
US

IV. Provider business mailing address

2525 YOUREE DR STE 110
SHREVEPORT LA
71104-3600
US

V. Phone/Fax

Practice location:
  • Phone: 769-251-5550
  • Fax:
Mailing address:
  • Phone: 318-742-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: