Jeanne Moore, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024168326 Issued in VA

Practice address

2200 Tacketts Mill Dr
Woodbridge
Woodbridge, VA 22192-3012

Phone

(703) 494-4961

NPI assigned

Sep 29, 2005

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 identifiers 8

Other names 1

• Jeanne Marie Carney Moore Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Custom Clinic, P.a.

  • Family Medicine Physician
  • Fairmont, MN
  • NPI 1699859124
  NPD (past)
• Desmoines Valley BHS

  • Clinical Nurse Specialist
  • Jackson, MN
  • NPI 1407065824
  NPD (past)

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1073500658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 TACKETTS MILL DR",
            "address_2": "WOODBRIDGE",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923012",
            "telephone_number": "703-494-4961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 TACKETTS MILL DR",
            "address_2": "WOODBRIDGE",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923012",
            "telephone_number": "703-494-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JEANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R 152237-0",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024168326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIOUX VALLEY HEALTH PLAN",
            "identifier": "23218",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "984639500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "1651881",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "141044",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MCR",
            "identifier": "500020824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-07324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "062J3CA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA2081029811",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "MOORE",
            "middle_name": "MARIE CARNEY",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mel Mondillo, RBT
• Helene Mongo
• Rebecca Moninghoff, LMT
• Mohammad Monireddin Ghazvini, M.D.
• Montclair Home Healthcare LLC
• Geoffrey D Moorer, M.D.
• Morami Healthcare Services LLC
• Eleanor Marlene Moran, BSN
• Michael Harold Morch, D.D.S.
• Rodolfo Alain Morera, R.D.M.S.

• Family Nurse Practitioner in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; 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.