Individual
JORDAN BREANNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
495 N SHILLING AVE, BLACKFOOT, ID 83221-2336
(435) 744-3535
Mailing address
591 TURIN WAY APT 26101, REXBURG, ID 83440-1583
(760) 881-5773
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
ID
Other
Enumeration date
06/20/2025
Last updated
06/20/2025
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