Active NPI
Ian J Moore, PHD, LP
- Clinical Psychologist
- North Little Rock, AR
National Provider Identifier
1265075253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301019281
- Practice address
- 2200 Fort Roots Dr
North Little Rock, AR 72114-1709 - Phone
- (501) 257-2152
- NPI assigned
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301019281 | MI | Primary |
Addresses
Primary practice location
2200 Fort Roots Dr
North Little Rock, AR 72114-1709
Mailing address
720 N Spruce St
Little Rock, AR 72205-3752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301019281 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1265075253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 N SPRUCE ST",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722053752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-2152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "IAN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301019281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.