Active NPI
Jonathan Moore
- Family Nurse Practitioner
- Clarksburg, WV
National Provider Identifier
1447764907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN76344-FNP-BC
- Practice address
- 1 Medical Ctr. Drive
Clarksburg, WV 26301 - Phone
- (304) 623-3461
- NPI assigned
- Nov 20, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN76344-FNP-BC | WV | Primary |
Addresses
Primary practice location
1 Medical Ctr. Drive
Clarksburg, WV 26301
Mailing address
328 New St
Bridgeport, WV 26330-1417
Phone (304) 918-4818
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| APRN76344-FNP-BC | Other | WA | WV FNP-BC LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN76344-FNP-BC | WV | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1447764907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 NEW ST",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263301417",
"telephone_number": "304-918-4818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CTR. DRIVE",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "26301",
"telephone_number": "304-623-3461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JONATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-20",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WV",
"license": "APRN76344-FNP-BC",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV FNP-BC LICENSE NUMBER",
"identifier": "APRN76344-FNP-BC",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.