Provider Demographics
NPI:1235875121
Name:MOORE, JASMIN AMON
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:AMON
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2502
Mailing Address - Country:US
Mailing Address - Phone:918-619-2102
Mailing Address - Fax:
Practice Address - Street 1:551 N 28TH WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-6139
Practice Address - Country:US
Practice Address - Phone:918-794-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator