Active NPI
Mallory Moore
- Clinical Social Worker
- Central City, KY
National Provider Identifier
1285058560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 254918
- Practice address
- 109 S 2ND St
Central City, KY 42330-1505 - Phone
- (270) 931-5113
- Fax
- (270) 754-4633
- NPI assigned
- Feb 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 254918 | KY | Primary |
Addresses
Primary practice location
109 S 2ND St
Central City, KY 42330-1505
Mailing address
PO Box 614
Hopkinsville, KY 42241-0614
Phone (270) 886-2205
Other practice location 1
3999 Fort Campbell Blvd
Hopkinsville, KY 42240-4929
Phone (270) 886-2205 ext. 133
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 254918 | KY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeskills, Inc. | Past | Accepting new patients | |
| Lifeskills, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmentally Disabled Services Day Training Agency
- Hopkinsville, KY
- NPI 1346321643
-
- Community/Behavioral Health Agency
- Bowling Green, KY
- NPI 1669401816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595462400000",
"number": "1285058560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 614",
"city": "HOPKINSVILLE",
"state": "KY",
"postal_code": "422410614",
"telephone_number": "270-886-2205",
"fax_number": "270-886-0392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 S 2ND ST",
"city": "CENTRAL CITY",
"state": "KY",
"postal_code": "423301505",
"telephone_number": "270-931-5113",
"fax_number": "270-754-4633"
}
],
"practiceLocations": [
{
"address_1": "3999 Fort Campbell Blvd",
"address_purpose": "LOCATION",
"city": "Hopkinsville",
"state": "KY",
"postal_code": "422404929",
"country_code": "US",
"telephone_number": "270-886-2205 x133",
"fax_number": "270-886-0392",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "MALLORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-07",
"last_updated": "2020-07-23",
"certification_date": "2020-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "254918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Central City, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.