Shirolyn Moffett M.D.,P.a.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

E0693 Issued in AR

Legal business name

SHIROLYN MOFFETT M.D.,P.A.

Practice address

715 W Sherman Ave
Suite D
Harrison, AR 72601-2743

Phone

(870) 204-5129

Fax

(870) 204-5131

NPI assigned

Jun 3, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shirolyn Ruth Moffett, M.D.

Title

President

Phone

(870) 204-5129

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275523200000",
    "number": "1700106549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 W SHERMAN AVE",
            "address_2": "SUITE D",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012743",
            "telephone_number": "870-204-5129",
            "fax_number": "870-204-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 W SHERMAN AVE",
            "address_2": "SUITE D",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012743",
            "telephone_number": "870-204-5129",
            "fax_number": "870-204-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIROLYN MOFFETT M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-03",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "SHIROLYN",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-204-5129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "E0693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131508001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.