Individual
JERICA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATC
Contact information
Practice address
1041 HAMILTION PLACE DR., JOHNSON CITY, TN 37604
(423) 707-2509
Mailing address
421 HIGHLAND AVE APT B, JOHNSON CITY, TN 37604-6847
(863) 381-8342
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2009
TN
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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