Karley Brooke Moore
Individual provider Active NPI Family Nurse Practitioner · Manila, AR
NPI 1114520491 · NPPES record last updated Jan 16, 2024
Key facts
- NPI
- 1114520491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 212805 (AR)
- Practice address
- 3644 W State Highway 18
Manila, AR 72442-8049 - Phone
- (708) 561-3300
- Fax
- (870) 561-3307
- NPI assigned
- Nov 18, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- T W Wagner Inc
Practice addresses (Care Compare)
1001 N 6TH St
Wagner Medical Clinic
Blytheville, AR 72315-1707
Phone (870) 281-2530
Hospital & facility affiliations
- St Bernards Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210712004087 | AR | Practitioner - Nurse Practitioner | 6103228291 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 212805 | AR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T W Wagner Inc | Family | Current |
Accepting new patients |
| St Bernards Physician Clinics Inc | Current |
Accepting new patients | |
| St Bernards Physician Clinics Inc | Current | Accepting new patients | |
| T W Wagner Inc | Current |
Accepting new patients | |
| St Bernards Physician Clinics Inc | Current |
Accepting new patients | |
| CSS Healthcare, LLC | Past |
Accepting new patients | |
| T W Wagner Inc | Past | Accepting new patients |
Locations
1001 N 6th St
Blytheville, AR 72315
Phone (870) 281-2530
1520 N Division St
Blytheville, AR 72315
Phone (870) 838-7300
1005 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 935-1242
730 Greenwood Ave
#B
Lepanto, AR 72354
Phone (870) 475-3825
730 Greenwood Ave
Lepanto, AR 72354
Phone (870) 475-3825
3644 W State Highway 18
Ste B
Manila, AR 72442
Phone (870) 561-3300
3644 W State Highway 18
Manila, AR 72442
Phone (870) 561-1500
Interoperability endpoints
- kbsexton@sbpc.medalliesdirect.net
- https://api.platform.athenahealth.com/16477/brand/1/csg/1/fhir/r4
- ksexton@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 212805 | AR | Yes |
Addresses
Primary practice location
3644 W State Highway 18
Manila, AR 72442-8049
Mailing address
624 Lanes Way
Manila, AR 72442-9136
Phone (870) 740-9800
Other providers in Manila, AR
- Romia Mays
- Megan McCrary
- Marilyn McGowan
- Candy McMinn
- Milestones Speech Therapy, LLC
- Morgan Bliss Noble
- Jessica Parrish
- Presley Raye Pierce
- Lacey Poe
- Rays Pediatric Therapy PLLC
All providers in Manila, AR · Family Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.