Individual
MRS. JENNIFER REBECCA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A.T., C., M.ED.
Contact information
Practice address
1190 S 18TH STREET EXT, OXFORD, MS 38655-5378
(662) 234-0424
(662) 234-0485
Mailing address
181 HIGHWAY 334, OXFORD, MS 38655-9402
(662) 281-8314
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0115
MS
Other
Enumeration date
07/14/2006
Last updated
07/08/2007
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