Mary Ann Moore

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

292594 Issued in AZ

Practice address

505 Whipple St
Prescott, AZ 86301-1747

Phone

(928) 232-5987

Fax

(928) 776-6496

NPI assigned

Jun 1, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• 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

Interoperability endpoints

• Direct secure messaging: maryann.moore.p1@direct.lifewell.nextgenshare.com

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.

• Lifewell Behavioral Wellness

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1417050337

  AZ

  Medicare reassignment NPD
• Moore Centered Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chandler, AZ
  • NPI 1356292742

  Psychiatric/Mental Health

  NPD
• Mingus Mountain Estate Residential Center Inc

  • Assisted Living Facility (Behavioral Disturbances)
  • Dewey, AZ
  • NPI 1114090925
  NPD (past)
• Mingus Mountain Estate Residential Center Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Prescott Valley, AZ
  • NPI 1356358519
  NPD (past)
• Mingus Mountain Estate Residential Center Inc

  • Assisted Living Facility (Behavioral Disturbances)
  • Prescott Valley, AZ
  • NPI 1497828503
  NPD (past)

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774569600000",
    "number": "1457044653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 WHIPPLE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011747",
            "telephone_number": "928-232-5987",
            "fax_number": "928-776-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 WHIPPLE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011747",
            "telephone_number": "928-232-5987",
            "fax_number": "928-776-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "292594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey Elaine Moore, LAC
• Bertha Jean Moore, RN
• Jennifer Anne Moore, FNP-BC
• Kristin Moore
• Laura Jeanne Moore, LPC
• Ronald Moore
• Jamie Moran
• Darwin Mordhorst
• John Morehead, LPC
• Eva Moreno

• All providers in Prescott, AZ
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; 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.