Provider Demographics
NPI:1467081000
Name:MOORE, JOSHUA WAYNE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WAYNE
Last Name:MOORE
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 STONEGATE DR STE F
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7323
Mailing Address - Country:US
Mailing Address - Phone:870-686-6500
Mailing Address - Fax:870-686-6555
Practice Address - Street 1:3501 STONEGATE DR STE F
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7323
Practice Address - Country:US
Practice Address - Phone:870-686-6500
Practice Address - Fax:870-686-6555
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122653363LF0000X
MO2020021031363LF0000X
WY53075363LF0000X
NE115034363LF0000X
COC-APN.0101204-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily