Provider Demographics
NPI:1740392398
Name:MOORE, JESSIE SHOWERS (RNC, CD)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:SHOWERS
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 SWEETBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-5149
Mailing Address - Country:US
Mailing Address - Phone:732-583-6634
Mailing Address - Fax:732-776-2329
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-2325
Practice Address - Fax:732-776-2329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N011005600163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health