Provider Demographics
NPI:1538210190
Name:MOORE, NITA (CRT)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 HIGHWAY 278 N
Mailing Address - Street 2:
Mailing Address - City:DIERKS
Mailing Address - State:AR
Mailing Address - Zip Code:71833-8802
Mailing Address - Country:US
Mailing Address - Phone:870-286-2152
Mailing Address - Fax:
Practice Address - Street 1:12915 HIGHWAY 278 N
Practice Address - Street 2:
Practice Address - City:DIERKS
Practice Address - State:AR
Practice Address - Zip Code:71833-8802
Practice Address - Country:US
Practice Address - Phone:870-286-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0552227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified