MEDICARE: BRIONNA SHANTAE 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	1041C0700X	Clinical Social Worker		NV

General Provider Information

NPI Number	:	1639007917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIONNA SHANTAE MOORE

Provider Business Mailing Address
First Line	:	5080 JERRY AVE
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89060-1707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 JERRY AVE
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89060-1707
Country	:	US
Telephone Number	:	775-513-1367
Fax Number	:

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

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “ BRIONNA SHANTAE MOORE ” Practice Location

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