Individual
MRS. JENNIFER E MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN, CSR
Contact information
Practice address
3870 LISCOTT RD, SOUTHAVEN, MS 38672-6780
(702) 533-2259
Mailing address
3870 LISCOTT RD, SOUTHAVEN, MS 38672-6780
(702) 533-2259
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
LDN0000001086
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0853
LICENSE
MS
Enumeration date
07/09/2008
Last updated
01/10/2022
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