Provider Demographics
NPI:1588096044
Name:MORAN, MICHELLE ANNETTE (BSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:MORAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-9382
Mailing Address - Country:US
Mailing Address - Phone:870-659-7002
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:201 WEST 2ND STREET
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2804
Practice Address - Country:US
Practice Address - Phone:501-676-3151
Practice Address - Fax:501-676-3152
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator