Provider Demographics
NPI:1508919358
Name:MOORE, JENNIFER E (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 SPRINGHOUSE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1609
Mailing Address - Country:US
Mailing Address - Phone:615-826-2080
Mailing Address - Fax:615-822-3213
Practice Address - Street 1:100 SPRINGHOUSE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1609
Practice Address - Country:US
Practice Address - Phone:615-826-2080
Practice Address - Fax:615-822-3213
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD026653208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3097270Medicaid
TN3097270Medicaid