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General NPI Number Information
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NPI Number | 1588532279
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Entity Type | Individual
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Provider Name | RENITA L MOORE RN
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Gender | Female
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Dates
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Enumeration Date | 10/25/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 305 BLAIR CIR
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City | PEA RIDGE
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State | AR
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Zip | 72751-3183
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Country | US
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Telephone | 479-381-1029
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Fax | 479-208-7485
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Provider Business Mailing Address
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Address Line | 305 BLAIR CIR
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City | PEA RIDGE
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State | AR
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Zip | 72751-3183
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Country | US
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Telephone | 479-381-1029
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Fax | 479-208-7485
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | R045021
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License Number State | AR
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