Provider Demographics
NPI:1366059156
Name:MOORE, JAMIE LEIGH (RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771-7860
Mailing Address - Country:US
Mailing Address - Phone:256-218-1996
Mailing Address - Fax:
Practice Address - Street 1:6345 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7860
Practice Address - Country:US
Practice Address - Phone:256-218-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072536363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool