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General NPI Number Information
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NPI Number | 1598235889
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE MOORE MSN, PMHNP-BC, RN
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Gender | Female
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 701 NE 136TH AVE STE 200
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City | VANCOUVER
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State | WA
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Zip | 98684-6937
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Country | US
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Telephone | 360-322-4711
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Fax | 360-583-6404
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Provider Business Mailing Address
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Address Line | 701 NE 136TH AVE STE 200
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City | VANCOUVER
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State | WA
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Zip | 98684-6937
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Country | US
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Telephone | 360-322-4711
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Fax | 360-583-6404
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 60911808
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License Number State | WA
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