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General NPI Number Information
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NPI Number | 1639976186
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Entity Type | Individual
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Provider Name | EDGAR MOYA
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Gender | Male
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1609 P AVE
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City | KEARNEY
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State | NE
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Zip | 68847-4003
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Country | US
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Telephone | 308-746-3652
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 E 45TH ST APT K5
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City | KEARNEY
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State | NE
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Zip | 68847-4161
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Country | US
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Telephone | 308-746-3652
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Fax |
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | 73608402
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 73608402
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | 73608402
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License Number State | NE
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