Individual
JENNIFER FRANCES MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA-C
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-3076
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
3
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AA0002
—
SC
01
—
C0650
MEDCOST
—
Enumeration date
10/25/2005
Last updated
01/13/2022
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