Provider Demographics
NPI:1760878649
Name:MOORE FELTON, JOI ALICIA
Entity Type:Individual
Prefix:
First Name:JOI
Middle Name:ALICIA
Last Name:MOORE FELTON
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 1:3200 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2213
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:
Practice Address - Street 1:3200 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3019
Practice Address - Country:US
Practice Address - Phone:513-558-7700
Practice Address - Fax:513-558-5055
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1323122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program