Provider Demographics
NPI:1578850574
Name:MOORE, TOMEKA CHERIE
Entity Type:Individual
Prefix:MISS
First Name:TOMEKA
Middle Name:CHERIE
Last Name:MOORE
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 1:1912 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2662
Mailing Address - Country:US
Mailing Address - Phone:501-749-2086
Mailing Address - Fax:
Practice Address - Street 1:4701 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8066
Practice Address - Country:US
Practice Address - Phone:501-771-8261
Practice Address - Fax:501-771-8263
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator