Individual
JEDD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
300 W MYRTLE ST STE 100, BOISE, ID 83702-7690
(208) 472-9082
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
59377
ID
Other
Enumeration date
09/20/2018
Last updated
07/15/2021
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