Provider Demographics
NPI:1093010654
Name:MOORE, JENNIFER KAY (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-0275
Mailing Address - Country:US
Mailing Address - Phone:405-657-9265
Mailing Address - Fax:
Practice Address - Street 1:308 PENNY CIR
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-9272
Practice Address - Country:US
Practice Address - Phone:405-657-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist