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NPI Code Detail

MEDICARE: REGINA MOORE CNP

MEDICARE: REGINA MOORE CNP
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
1363LF0000XFamily Nurse PractitionerA005057AR

General Provider Information

NPI Number : 1881120715
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA MOORE CNP
Provider Business Mailing Address
First Line : 1652 STATE HIGHWAY 22 W
Second Line :
City : DARDANELLE
State : AR
Zip : 72834-2909
Country : US
Telephone Number : 479-229-8000
Fax Number : 479-477-3925
Provider Business Practice Location Address
First Line : 1652 STATE HIGHWAY 22 W
Second Line :
City : DARDANELLE
State : AR
Zip : 72834-2909
Country : US
Telephone Number : 479-229-8000
Fax Number : 479-477-3925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 07/15/2025

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Directions to “ REGINA MOORE CNP” Practice Location

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