Provider Demographics
NPI:1215020920
Name:MOORE, VICKI HURLEY (APN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:HURLEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:614 E EMMA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4634
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:479-751-4898
Practice Address - Street 1:500 S MOUNT OLIVE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3602
Practice Address - Country:US
Practice Address - Phone:479-524-9550
Practice Address - Fax:479-524-9552
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARAO1821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5-Y752OtherBLUE CROSS BLUE SHIELD