Basic Information
| Provider Information | |||||||||
| NPI: | 1740392398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | SHOWERS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNC, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 359 SWEETBRIAR ST | ||||||||
| Address2: | |||||||||
| City: | KEYPORT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077355149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325836634 | ||||||||
| FaxNumber: | 7327762329 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 STATE ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
| FaxNumber: | 7327762329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 26N011005600 | NJ | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.