Individual
JORDAN RUSSELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
206 S MULBERRY ST STE A, MOUNT VERNON, OH 43050-3331
(740) 326-9988
(740) 326-1175
Mailing address
206 S MULBERRY ST STE A, MOUNT VERNON, OH 43050-3331
(740) 326-9988
(740) 326-1175
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN.CNP.025092
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.025092
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN.CNP.025092
STATE LICENSE NUMBER
OH
Enumeration date
04/18/2019
Last updated
07/25/2025
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