Individual
MRS. JACQUELINE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
314 MAIN ST STE D, MONTICELLO, MS 39654-3702
(601) 587-4304
Mailing address
1314 ZETUS RD NW, BROOKHAVEN, MS 39601-8309
(601) 757-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
859952
MS
363LF0000X
Family Nurse Practitioner
Primary
902473
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
902473
FNP LICENSE
MS
05
—
902473
—
MS
Enumeration date
03/03/2018
Last updated
12/06/2021
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