Provider Demographics
NPI:1881674265
Name:MOORE, CAROLE E (APN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1 MERCY LANE
Mailing Address - Street 2:STE 401
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-623-5220
Mailing Address - Fax:501-623-1546
Practice Address - Street 1:#1 MERCY LANE
Practice Address - Street 2:STE 401
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-5220
Practice Address - Fax:501-623-1546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
5Y544Medicare ID - Type Unspecified
Q55342Medicare UPIN