Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jordan Russell Moore

Individual provider Family Nurse Practitioner · NPI 1821651571

Jordan Russell Moore is a Nurse Practitioner in Mount Vernon, Ohio. Qualified in 2019, 7 years ago. Practices with Revive Behavioral Health, LLC, a 4-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
7
Licensed in
OH
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

206 S Mulberry St Ste A
Mount Vernon, OH 43050-3331
Phone: (740) 326-9988
Fax: (740) 326-1175
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence APRN.CNP.025092 (OH)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence APRN.CNP.025092 (OH)

Record details

NPI number1821651571
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 18, 2019
Last updated in NPPESJuly 25, 2025
Certification dateJuly 25, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Revive Behavioral Health, Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

Other providers in Mount Vernon