MEDICARE: JAN ALLISON MOORE PH.D.

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	231H00000X	Audiologist	267	NE

General Provider Information

NPI Number	:	1679098768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN ALLISON MOORE PH.D.

Provider Business Mailing Address
First Line	:	6116 M AVE
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68847-1563
Country	:	US
Telephone Number	:	308-224-3229
Fax Number	:	308-865-8397

Provider Business Practice Location Address
First Line	:	1615 W 24TH STREET
Second Line	:	UNK SPEECH & HEARING CLINIC
City	:	KEARNEY
State	:	NE
Zip	:	68849
Country	:	US
Telephone Number	:	308-865-8301
Fax Number	:	308-865-8397

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

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/09/2017

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