Andrea Moore, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

904214 Issued in MS

Practice address

971 Lakeland Dr
Jackson, MS 39216-4643

Phone

(601) 200-2000

NPI assigned

Nov 19, 2020

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

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Dominic Jackson MemorialGroup PAC ID 4385531847, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• St. Dominic Jackson Memorial

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1235173691
  Medicare reassignment Care Compare group NPD
• Medical Foundation of Central Mississippi, Inc.

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1992774814
  Medicare reassignment NPD
• Mobile Wound Care Solutions LLC

  • Specialist
  • Cincinnati, OH
  • NPI 1548070014

  MS

  Medicare reassignment NPD
• Regional Healthcare Group LLC

  • Acute Care Nurse Practitioner
  • Mount Juliet, TN
  • NPI 1407587363

  MS

  Medicare reassignment NPD
• Medical Foundation of Central Ms

  • Family Medicine Physician
  • Brandon, MS
  • NPI 1114264264
  NPD
• St Dominic Hospital Crna'S

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
  • NPI 1467682195
  NPD
• Guardian Biologics LLC

  • Specialist
  • Mount Juliet, TN
  • NPI 1033890876
  NPD
• BMC - Attala, LLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1023481595
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1336742410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-200-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-200-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Baptist Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391102010",
            "country_code": "US",
            "telephone_number": "601-605-2383",
            "fax_number": "601-605-8510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ANDREA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904214",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "904214",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorena Moody, PHARM. D.
• Richard Craig Mooney, RRT
• Moore Healthy Family Medical Clinic, LLC
• Sheena Moore-Carter, FNP
• Alan Rather Moore, MD
• Bridgett Moore
• Candice M. Moore, OTR L
• Cooper Bufkin Moore, PSY.D.
• Daniel Moore
• Derrick Michael Moore, LMSW

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.