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General NPI Number Information
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NPI Number | 1013889633
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Entity Type | Individual
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Provider Name | JAYMIE MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 220 S VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-5812
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Country | US
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Telephone | 580-234-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 W CHESTNUT AVE
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City | ENID
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State | OK
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Zip | 73703-3908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 225170
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License Number State | OK
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