Individual
MRS. JACQUELINE MARIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, PMHNP-BC, RN
Contact information
Practice address
701 NE 136TH AVE STE 200, VANCOUVER, WA 98684-6937
(360) 322-4711
(360) 583-6404
Mailing address
701 NE 136TH AVE STE 200, VANCOUVER, WA 98684-6937
(360) 322-4711
(360) 583-6404
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
60911808
WA
Other
Enumeration date
11/29/2018
Last updated
05/30/2025
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