Active NPI
Brandy Moore
- Counselor
- Carbondale, IL
National Provider Identifier
1427667161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 200 N Emerald LN
Carbondale, IL 62901-2159 - Phone
- (618) 457-6703
- NPI assigned
- Jul 29, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | IL | Primary |
Addresses
Primary practice location
200 N Emerald LN
Carbondale, IL 62901-2159
Mailing address
902 W Main St
West Frankfort, IL 62896-2210
Phone (618) 937-6483
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IL2970 | Medicaid | IL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1427667161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 W MAIN ST",
"city": "WEST FRANKFORT",
"state": "IL",
"postal_code": "628962210",
"telephone_number": "618-937-6483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N EMERALD LN",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629012159",
"telephone_number": "618-457-6703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BRANDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-29",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "IL2970",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.