Healthcare Provider Details

I. General information

NPI: 1497330591
Provider Name (Legal Business Name): JESSICA LORRAINE MOSHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S 2ND ST
TALENT OR
97540-9750
US

IV. Provider business mailing address

503 S 2ND ST
TALENT OR
97540-9750
US

V. Phone/Fax

Practice location:
  • Phone: 530-840-4894
  • Fax:
Mailing address:
  • Phone: 530-840-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberTHW000104330
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10011983
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: