Healthcare Provider Details

I. General information

NPI: 1780855957
Provider Name (Legal Business Name): JODI MOORE RRT, RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ASCENSION DR APT C107
ASHEVILLE NC
28806-1972
US

IV. Provider business mailing address

99 ASCENSION DR APT C107
ASHEVILLE NC
28806-1972
US

V. Phone/Fax

Practice location:
  • Phone: 828-332-1548
  • Fax:
Mailing address:
  • Phone: 828-332-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberA-3837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: