Michelle Laverne Jacobs, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95000824 Issued in CA

Practice address

2140 Professional Dr Ste 210
Roseville, CA 95661-3776

Phone

(916) 782-5511

NPI assigned

Nov 13, 2014

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

Other names 1

• Michelle Laverne Moore Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Alexander Y Chan, MD Inc

  • Family Medicine Physician
  • Turlock, CA
  • NPI 1831360809
  Medicare reassignment NPD
• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753
  Medicare reassignment NPD
• Minuteclinic Diagnostic Medical Group of Orange County Inc

  • Nurse Practitioner
  • Irvine, CA
  • NPI 1104013879

  Family

  Medicare reassignment NPD
• Golden Valley Health Centers

  dba GVHC Pharmacy

  • Community/Retail Pharmacy
  • Merced, CA
  • NPI 1093817405
  NPD
• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Ceres, CA
  • NPI 1902456726
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1487867503
  NPD (past)

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1356747687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 PROFESSIONAL DR STE 210",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613776",
            "telephone_number": "916-612-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 PROFESSIONAL DR STE 210",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613776",
            "telephone_number": "916-782-5511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Benton St",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "CA",
            "postal_code": "950504854",
            "country_code": "US",
            "telephone_number": "916-612-3034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1801 Eureka Rd Apt 453",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956617772",
            "country_code": "US",
            "telephone_number": "916-612-3034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MICHELLE",
        "middle_name": "LAVERNE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-13",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95000824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTIONER LICENSE NUMBER",
            "identifier": "95000824",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "MOORE",
            "middle_name": "LAVERNE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Fredrick Jackson, DD.S.
• Roland Ignatius Jackson Jr., PT
• T Theresa Jackson, MT-BC
• Jacob D Kelly DDS, Inc.
• James Charles Jacobs, M.D.
• Jacobson Dental Corp (Children's Choice Dental Care)
• Mark J Jacobson, LCSW
• Kailey Nicole Jacques
• Karla Marques Jacskon
• Fatima Jafri, M.D.

• Family Nurse Practitioner in Roseville, CA
• Providers in Roseville, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.