Gambrell Moore

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

800753572 Issued in MS

Practice address

4271 Cypress Dr # 42
Jackson, MS 39212-3406

Phone

(601) 983-6016

NPI assigned

Mar 19, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1184200255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4271 CYPRESS DR # 42",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392123406",
            "telephone_number": "601-983-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4271 CYPRESS DR # 42",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392123406",
            "telephone_number": "601-983-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "GAMBRELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MS",
            "license": "800753572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861625652",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cooper Bufkin Moore, PSY.D.
• Daniel Moore
• Derrick Michael Moore, LMSW
• Dusharme Lakiva-Ann Moore, NP
• Ellyssya B Moore, BCBA
• James Bill Moore Jr., MD
• James Love Moore Jr., M.D.
• Jane Ann Lampton Moore, M.D.
• Justin Boone Moore, MD
• Keri H Moore, PT, DPT, NCS

• Home Health Aide in Jackson, MS
• Providers in Jackson, MS by specialty
• Home Health Aide in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.