JACKIE COOMBE-MOORE PA (NPI# 1841513223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841513223 |
| Entity Type | Organization |
| Organization Name | JACKIE COOMBE-MOORE PA |
| Other Organization Name | CONWAY PSYCHIATRIC CENTER |
| Practice Address |
680 Hogan Ln Conway AR 72034-8131 |
| Practice Telephone | 5015058900 |
| Practice Fax Number | 5015058902 |
| Mailing Telephone | 5015058900 |
| Mailing Fax Number | 5015058902 |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2010-03-26 |
| Authorized Official Name | JACKIE COOMBE-MOORE (PRESIDENT) |
| Authorized Official Telephone | 5015058900 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | QCA | 11547000000 | 01 |
| AR | 122013001 | 05 | |
| AR | MEDICARE PTAN | 55779 | 01 |
| Other Name | Type Code |
|---|---|
| Conway Psychiatric Center | Doing Business As Name - Organization |
| Street Address |
680 HOGAN LN |
| City | CONWAY |
| State | AR |
| Zip Code | 72034-8131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003843277 | Jo Ann Clay | Registered Nurse | 680 Hogan Ln, Conway, AR 72034-8131 | 2006-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013563758 | Shelby M Perez | Case Manager/Care Coordinator | 3240 Stermer Rd, Conway, AR 72034 | 2019-08-16 |
| 1467932772 | Faith J Parfait | Licensed Practical Nurse | 1352 Watkins St, Conway, AR 72034 | 2018-08-16 |
| 1043790611 | David Adam Steinfeld | Nurse Practitioner | 855 S German Ln Ste 1, Conway, AR 72034 | 2018-08-14 |
| 1245728484 | Conway Behavioral Health, LLC | Psychiatry & Neurology | 2255 Sturgis Rd, Conway, AR 72034 | 2018-04-24 |
| 1972007292 | Eldercare of Arkansas IIi, Inc. | Assisted Living Facility | 1306 S. Donaghey, Conway, AR 72034 | 2018-03-21 |
| 1528561404 | Kouhei Kobayashi | Specialist/Technologist | 2201 Moix Blvd., Apt. 908, Conway, AR 72034 | 2018-03-16 |
| 1780191015 | Sydnie Thessing | Nurse Practitioner | 605 Dave Ward Drive #105, Conway, AR 72034 | 2018-01-09 |
| 1508371865 | Ebony Latreace Charleston | Case Manager/Care Coordinator | 3240 Stermer Road, Conway, AR 72034 | 2017-12-08 |
| 1689190647 | Denise Annette Aikman | Dentist | 1210 Hogan Lane, Suite 200, Conway, AR 72034 | 2017-08-21 |
| 1134669138 | Hortons Orthotic Lab, Inc. | Prosthetic/Orthotic Supplier | 635 Dave Ward, Suite 103, Conway, AR 72034 | 2017-02-24 |
| Find all providers in zip 72034 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245728484 | Conway Behavioral Health, LLC | Psychiatry & Neurology | 2255 Sturgis Rd, Conway, AR 72034 | 2018-04-24 |
| 1750483699 | Raymond H Clark | Psychiatry & Neurology | 5330 Plantation Cv, Conway, AR 72034-8586 | 2006-09-01 |
| 1801876446 | Daniel Pistone Md Pa | Psychiatry & Neurology | 3185 Wildhorse Dr, Conway, SC 29526-7817 | 2006-01-19 |
| 1659370021 | Kurt Klauburg | Psychiatry & Neurology | 164 Waccamaw Medical Park Dr, Conway, SC 29526-8903 | 2005-07-19 |
| 1548603764 | Michael Conrad Dennis | Psychiatry & Neurology | 1520 E Dave Ward Dr, Conway, AR 72032-9649 | 2013-04-08 |
| 1972808145 | Conway Psychiatric Clinic, Pllc | Psychiatry & Neurology | 5330 Plantation Cv, Conway, AR 72034-8586 | 2011-01-20 |
| 1205090933 | Olga Victa | Psychiatry & Neurology | 164 Waccamaw Medical Park Dr, Conway, SC 29526-8903 | 2008-07-11 |
| 1407063068 | Karen Young Md.pa | Psychiatry & Neurology | 2302 College Ave, Conway, AR 72034-6297 | 2007-05-16 |
| 1871718890 | Jennifer Middleton | Psychiatry & Neurology | 350 Salem Rd Ste 1, Conway, AR 72034-6166 | 2007-04-16 |
| 1689794604 | Melissa Myers | Psychiatry & Neurology | 25 W Main St, Conway, NH 03818-6142 | 2007-03-31 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.