MEDICARE: JEANNE SMITH MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1371	NC

General Provider Information

NPI Number	:	1558219154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE SMITH MOORE

Provider Business Mailing Address
First Line	:	1105 PEACHTREE RD NW
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-2023
Country	:	US
Telephone Number	:	252-399-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 CORBETT AVE N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-1909
Country	:	US
Telephone Number	:	253-399-7973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “ JEANNE SMITH MOORE ” Practice Location

Language	Start Address	Practice Location

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