Provider Demographics
NPI:1740264027
Name:MORIARTY, MARY SHA (APN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:SHA
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:4800 RIDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9255
Mailing Address - Country:US
Mailing Address - Phone:501-257-5860
Mailing Address - Fax:501-257-5813
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:111J/LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-5860
Practice Address - Fax:501-257-5813
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-04-15
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Provider Licenses
StateLicense IDTaxonomies
AR168357363LA2200X
ARA01121ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health