Individual
JESSE JAMES MOORE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3430 E RUSSELL RD STE 320, LAS VEGAS, NV 89120-2201
(702) 522-7964
(702) 522-7998
Mailing address
3430 E RUSSELL RD STE 320, LAS VEGAS, NV 89120-2201
(702) 522-7964
(702) 522-7998
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
NV
175T00000X
Peer Specialist
Primary
PRSS-5296
NV
Other
Enumeration date
10/13/2025
Last updated
10/21/2025
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