Chaquita M Moore, FNP
Individual provider Active NPI Family Nurse Practitioner · Dublin, GA
NPI 1205980844 · NPPES record last updated Oct 31, 2017
Key facts
- NPI
- 1205980844
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN138492 NP (GA)
- Practice address
- 160 Spring Branch Dr
Dublin, GA 31021-0356 - Phone
- (478) 274-8489
- Fax
- (478) 275-0731
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN138492 NP | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geriatric Ancillary Services Inc | Past | Accepting new patients |
Interoperability endpoints
- ms_cmoor40@landmarkhealth-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN138492 NP | GA | Yes |
Addresses
Primary practice location
160 Spring Branch Dr
Dublin, GA 31021-0356
Mailing address
205 Fox Den CT
Dublin, GA 31021-4361
Phone (478) 361-9621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RN138492 NP | Other | GA | LICENSE |
Other names
- Chaquita Martin
Other providers in Dublin, GA
- Lisa Veal Montford
- Gene Moody
- Stephanie L Moody
- Moore Anesthesia Services, Inc
- Antoinet Moore
- Dana Lewis Moore
- Edward L. Moore
- Kara Kirz Moore
- Lucinda L. Moore
- Michaela Marie Moore
All providers in Dublin, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.