MEDICARE: MS. RHONDA MOFFETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1184163537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA MOFFETT

Provider Business Mailing Address
First Line	:	2525 YOUREE DR STE 110
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3600
Country	:	US
Telephone Number	:	318-742-3408
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 E RIVER PL STE 100
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-3442
Country	:	US
Telephone Number	:	769-251-5550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/17/2017

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Directions to “ MS. RHONDA MOFFETT ” Practice Location

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