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NPI Code Detail

MEDICARE: JESSICA MOORE MS

MEDICARE: JESSICA MOORE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist201132

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2184607OTHERKYMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831125855
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MOORE MS
Provider Business Mailing Address
First Line : 2330 CONCRETE RD
Second Line :
City : CARLISLE
State : KY
Zip : 40311-9700
Country : US
Telephone Number : 859-289-7126
Fax Number :
Provider Business Practice Location Address
First Line : 2330 CONCRETE RD
Second Line :
City : CARLISLE
State : KY
Zip : 40311-9700
Country : US
Telephone Number : 859-289-7126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 11/30/2011

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