Provider Demographics
NPI:1528193877
Name:MOORE, EVON (CASEWORKER)
Entity Type:Individual
Prefix:MRS
First Name:EVON
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CASEWORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635
Mailing Address - Country:US
Mailing Address - Phone:870-304-3447
Mailing Address - Fax:
Practice Address - Street 1:1802 HWY 82 W
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635
Practice Address - Country:US
Practice Address - Phone:870-364-7248
Practice Address - Fax:870-364-2249
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator