Provider Demographics
NPI:1285141341
Name:MOFFITT, JESSICA ANN BERG (BS, CHES)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN BERG
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:BS, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3810
Mailing Address - Country:US
Mailing Address - Phone:785-955-9228
Mailing Address - Fax:860-239-8243
Practice Address - Street 1:209 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3810
Practice Address - Country:US
Practice Address - Phone:785-955-9228
Practice Address - Fax:860-239-8243
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25938174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator