Marty Jo Moore, RN

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

2020 W Spaulding St
Boise, ID 83705-3551

Phone

(208) 721-2045

NPI assigned

Jan 18, 2021

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

Other names 1

• Marty Jo Moore Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1033708623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W SPAULDING ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837053551",
            "telephone_number": "208-721-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W SPAULDING ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837053551",
            "telephone_number": "208-721-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARTY",
        "middle_name": "JO",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-18",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DL",
            "identifier": "ZC248462K",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nursemarty69@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "general",
            "address_1": "2020 W Spaulding St",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837053551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARTY",
            "last_name": "MOORE",
            "middle_name": "JO",
            "credential": "RN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Keith Michael Moore, LPC
• Kelly Moore, NP
• Kyra Moore, RN
• Levi Moore
• Mark Owen Moore, M.D.
• Matt Townsend Moore, MD
• Monte H Moore, MD
• Patricia A. Moore, LCSW
• Patricia E. Moore, NP
• Richard E Moore, MD

• Counselor in Boise, ID
• Providers in Boise, ID by specialty
• Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.