MEDICARE: JENNIFER ANN MOORE PA-C

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	363A00000X	Physician Assistant	PA03754	TX

General Provider Information

NPI Number	:	1568636876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN MOORE PA-C

Provider Business Mailing Address
First Line	:	ONE RIVERWAY
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77056-1993
Country	:	US
Telephone Number	:	281-381-6133
Fax Number	:	713-482-3259

Provider Business Practice Location Address
First Line	:	ONE RIVERWAY
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77056-1993
Country	:	US
Telephone Number	:	281-381-6133
Fax Number	:	713-482-3259

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	09/22/2011

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