Provider Demographics
NPI:1033257837
Name:MOYER, SHIRLEY A
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:MOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72579-9783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 MYERS ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7344
Practice Address - Country:US
Practice Address - Phone:870-793-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator