Provider Demographics
NPI:1629465919
Name:MORENO, PATRICIA (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SHACKLEFORD WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3886
Mailing Address - Country:US
Mailing Address - Phone:501-664-5860
Mailing Address - Fax:501-664-0889
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3886
Practice Address - Country:US
Practice Address - Phone:501-664-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004378363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004378OtherSTATE LICENSE