Provider Demographics
NPI:1659151876
Name:MOORE, JAKORRIA
Entity Type:Individual
Prefix:
First Name:JAKORRIA
Middle Name:
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 1:611 CRUMPTON DR SW APT C
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4673
Mailing Address - Country:US
Mailing Address - Phone:205-401-9972
Mailing Address - Fax:
Practice Address - Street 1:611 CRUMPTON DR SW APT C
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4673
Practice Address - Country:US
Practice Address - Phone:205-401-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool