Susan John Moore, F.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71003756A Issued in IN

Practice address

3118 South Lafountain
Indiana Health Center - Kokomo
Kokomo, IN 46902-3710

Phone

(765) 864-4160

Fax

(765) 864-4166

NPI assigned

Sep 8, 2011

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: susan.moore.1@20754.direct.athenahealth.com

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1134400864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "317-343-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 SOUTH LAFOUNTAIN",
            "address_2": "INDIANA HEALTH CENTER - KOKOMO",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023710",
            "telephone_number": "765-864-4160",
            "fax_number": "765-864-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SUSAN",
        "middle_name": "JOHN",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-08",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71003756A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003756A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071250A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette M Moore, MD
• Duane W Moore, LMHC
• Jeri H Moore, M.A.
• Molly Moore, RBT
• Ronald Pete Moore
• Jasmin Morales
• Janice Elaine Morecraft, NP
• Lilly Morgan
• Matthew Morgan
• Megan Morgan

• Family Nurse Practitioner in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.