Provider Demographics
NPI:1851695464
Name:MOORE, JAMIE PALMER (RD/LDN, MPH)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:PALMER
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD/LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4203
Mailing Address - Country:US
Mailing Address - Phone:863-676-1433
Mailing Address - Fax:863-679-6867
Practice Address - Street 1:410 SOUTH 11TH STREET
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853
Practice Address - Country:US
Practice Address - Phone:863-676-1433
Practice Address - Fax:863-679-6867
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND88133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered