Jennifer E Moore, MS, RDN, LDN, CSR

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

LDN0000001086 Issued in TN

Practice address

3870 Liscott Rd
Southaven, MS 38672-6780

Phone

(702) 533-2259

NPI assigned

Jul 9, 2008

Last updated

Jan 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nourish, Inc.Group PAC ID 1557724937, 288 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824
  Medicare reassignment Care Compare group NPD
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1023271962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3870 LISCOTT RD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726780",
            "telephone_number": "702-533-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3870 LISCOTT RD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726780",
            "telephone_number": "702-533-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JENNIFER",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "MS, RDN, LDN, CSR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "TN",
            "license": "LDN0000001086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0853",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rena D Montgomery, APN
• Lacey Moody
• Moore Speech Therapy, LLC (Moore Pediatric Therapy)
• Anna Moore
• Apryl Suzanne Moore, SLP
• Raven Victoria Moore, MOT/S
• Sarah Katherine Moore, LPC
• Terrica Moore, DNP, CPNP-PC
• Oterrious L Moorehead
• Cynthia Morano, RN

• Renal Nutrition Registered Dietitian in Southaven, MS
• Providers in Southaven, MS by specialty
• Renal Nutrition Registered Dietitian in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.