Mary Kate Moore, APRN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

17793 Issued in TN

Practice address

2707 Jacksboro Pike
Suite 1a
Jacksboro, TN 37757-2752

Phone

(423) 907-8186

Fax

(423) 907-8187

NPI assigned

Jul 19, 2013

Last updated

Oct 4, 2013By the provider in NPPES

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 TN

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minuteclinic Diagnostic of Tennessee PC

  • Family Nurse Practitioner
  • Nashville, TN
  • NPI 1457323164
  Medicare reassignment NPD
• Renovation Health and Wellness

  • Family Health Clinical Nurse Specialist
  • Jacksboro, TN
  • NPI 1336561943
  Medicare reassignment NPD

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380844800000",
    "number": "1457793382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 BRUCE GAP RD",
            "city": "CARYVILLE",
            "state": "TN",
            "postal_code": "377143832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 JACKSBORO PIKE",
            "address_2": "SUITE 1A",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "377572752",
            "telephone_number": "423-907-8186",
            "fax_number": "423-907-8187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "KATE",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-19",
        "last_updated": "2013-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "17793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mercy Women's Center
• Frank Townsend Metelka, DDS
• Lori M Middleton
• Barbara Milton
• Alissa Dower Miracle, PHARMD
• Jennifer Maria Muggridge, APRN
• Laura Kaleigh Mundy, FNP-BC
• Myeyedr Optometry of Tennessee, LLC (MyEyeDr.)
• Kevin A Mysliwiec, O.D.
• Sandy L Mysliwiec, O.D.

• Family Nurse Practitioner in Jacksboro, TN
• Providers in Jacksboro, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; 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.