MEDICARE: LENREYAH MOORE APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	229753	AR

General Provider Information

NPI Number	:	1902644727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENREYAH MOORE APRN

Provider Business Mailing Address
First Line	:	1100 N UNIVERSITY AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-6343
Country	:	US
Telephone Number	:	501-663-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 N UNIVERSITY AVE STE 125
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-6356
Country	:	US
Telephone Number	:	501-663-0055
Fax Number	:

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

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	02/02/2026

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