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NPI Code Detail

MEDICARE: JERRI MOORE

MEDICARE: JERRI 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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1962018218
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRI MOORE
Provider Business Mailing Address
First Line : 7517 COBAL CANYON LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-2903
Country : US
Telephone Number : 702-339-0356
Fax Number :
Provider Business Practice Location Address
First Line : 7517 COBAL CANYON LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-2903
Country : US
Telephone Number : 702-339-0356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2020
Last Update Date : 09/22/2020

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Directions to “ JERRI MOORE ” Practice Location

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