Individual provider Active NPI

Kaitlynn Moore, NP

  • Family Nurse Practitioner
  • Thomasville, GA
National Provider Identifier
1386501575
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
GAA-NP004374 Issued in GA
Practice address
116 Mimosa Dr
Thomasville, GA 31792-6605
Phone
(229) 551-0083
Fax
(229) 584-7174
NPI assigned
Jan 8, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X GAA-NP004374 GA Primary

Addresses

Primary practice location

116 Mimosa Dr
Thomasville, GA 31792-6605

Mailing address

116 Mimosa Dr
Thomasville, GA 31792-6605
Phone (229) 551-0083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20260219001502 GA Practitioner - Nurse Practitioner 9133609993 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CCSG, IncGroup PAC ID 6103130745, 25 clinicians

Practice addresses (Care Compare)

116 Mimosa Dr
Thomasville, GA 31792-6605
Phone (229) 551-0083

Hospital & facility affiliations

  • Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038
  • Grady General Hospital Hospital, Cairo, GA, CCN 110121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
GAA-NP004374GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
CCSG, Inc. CurrentSince Jan 9, 2026 Accepting new patients

Locations

100 Mimosa Dr
Thomasville, GA 31792
Phone (229) 226-9141

116 Mimosa Dr
Thomasville, GA 31792
Phone (229) 551-0083

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1767830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1386501575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926605",
            "telephone_number": "229-551-0083",
            "fax_number": "229-584-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MIMOSA DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926605",
            "telephone_number": "229-551-0083",
            "fax_number": "229-584-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KAITLYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-08",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "GAA-NP004374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.