Individual provider Active NPI

Jennifer Ann Moose, CNA

  • Home Health Aide
  • Waukon, IA
National Provider Identifier
1174498125
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
Practice address
101 7TH St NW
Waukon, IA 52172-1531
Phone
(563) 217-9439
Fax
(563) 568-3966
NPI assigned
Oct 9, 2025
Last updated
Oct 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X IA Primary

Addresses

Primary practice location

101 7TH St NW
Waukon, IA 52172-1531

Mailing address

101 7TH St NW
Waukon, IA 52172-1531
Phone (563) 217-9439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1759968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1174498125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 7TH ST NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521721531",
            "telephone_number": "563-217-9439",
            "fax_number": "563-568-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 7TH ST NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "521721531",
            "telephone_number": "563-217-9439",
            "fax_number": "563-568-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSE",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "CNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-09",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukon, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; 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.