Moore, Jacqueline

Moore, Jacqueline is an individual health care provider with primary practice located at 314 Main St Ste D , Monticello MS 39654-3702. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Moore, Jacqueline can be contacted via phone (601) 587-4304.

Contact Information

Primary practice address
314 Main St Ste D Monticello MS 39654-3702
Phone: (601) 587-4304
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 859952 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 902473 Mississippi

Profile Details

NPI number 1033611256
LBN Legal business name Moore, Jacqueline
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 3rd, 2018
Last updated Dec 6th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033611256 NPPES
Mississippi Other 902473 FNP LICENSE
Mississippi MEDICAID 902473 FNP LICENSE

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