Individual
MS. JENNIFER MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1110 KILDAIRE FARM RD, CARY, NC 27511-4523
(919) 481-0277
Mailing address
445 HOCUTT FARM DR, CLAYTON, NC 27527-3751
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001002915
NC
363A00000X
Physician Assistant
010268-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02670611
—
NY
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
P00204701
RR MEDICARE PIN
NY
Enumeration date
03/21/2006
Last updated
08/26/2022
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