Individual
JASON OTIS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W. AVE E ST., HOPE, AR 71801
(870) 773-0700
(870) 773-0705
Mailing address
2607 CADDO ST. - STE. 6, ARKADELPHIA, AR 71923-5307
(870) 230-8217
(870) 230-8201
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226648795
—
AR
Enumeration date
07/17/2015
Last updated
10/23/2019
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