Misty Moore Ivy, C.R.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R860233 Issued in MS

Practice address

7203 Goodman Rd
Olive Branch, MS 38654-1906

Phone

(901) 759-2322

NPI assigned

May 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Misty Ann Moore Other name

Medicare fee-for-service enrollment

Enrolled in MS, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology and Skin Cancer Associates, PLLCGroup PAC ID 2163501834, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Advanced Dermatology and Skin Cancer Associates, PLLC

  • Clinical & Laboratory Dermatological Immunology Physician
  • Germantown, TN
  • NPI 1265604888

  MS

  Medicare reassignment Care Compare group NPD
• Dr. Adam T Keres LLC.

  • Chiropractor
  • Memphis, TN
  • NPI 1376738351
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1063465482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 FORREST LAKE CV",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386327500",
            "telephone_number": "901-759-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7203 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541906",
            "telephone_number": "901-759-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE IVY",
        "first_name": "MISTY",
        "name_prefix": "Mrs.",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN11904",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R860233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "MOORE",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mississippi State Department of Health
• Tasha D Mitchell, LCSW
• Kenneth Carl Mitten, LCSW
• Callie Moffitt, RN
• Nicole Yvonne Monroe, O.D.
• S. Jeff Moore, DDS
• Kelly Sue Morgan, OTR/L
• Bianca Sade Moss, ST
• MSK Group, PC
• Stacey Castle Mueller, OTR/L

• Family Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.