Healthcare Provider Details

I. General information

NPI: 1710827191
Provider Name (Legal Business Name): JENNIFER MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 GLENWOOD AVE
YOUNGSTOWN OH
44511-1570
US

IV. Provider business mailing address

2125 GLENWOOD AVE
YOUNGSTOWN OH
44511-1570
US

V. Phone/Fax

Practice location:
  • Phone: 855-393-1335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041633
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: