Doctor Name: | MRS. JENNIFER E MOORE |
NPI Number: | 1023271962 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, RDN, LDN, CSR |
License Number: | LDN0000001086 |
Business Practice Address: | 3870 Liscott Rd Southaven, MS - 386726780 |
Business Phone Number: | 7025332259 |
Business Fax Number: | |
Mailing Address: | 3870 Liscott Rd, SOUTHAVEN |
State: | MS |
Postal Code: | 386726780 |
Phone Number: | 7025332259 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2008 |
NPI Last Update Date: | 08/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1005X |
License Number: | LDN0000001086 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Renal |
Taxonomy Definition: |