Mary Kate Moore, APRN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Jacksboro, TN
NPI 1457793382 · NPPES record last updated Oct 4, 2013
Key facts
- NPI
- 1457793382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 17793 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130827000356 | TN | Practitioner - Nurse Practitioner | 5496998213 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Renovation Health and Wellness | Current |
Accepting new patients | |
| Minuteclinic Diagnostic of Tennessee PC | Family | Current |
Accepting new patients |
Locations
2707 Jacksboro Pike
Ste 1A
Jacksboro, TN 37757
Phone (423) 907-8186
1200 Gallatin Pike S
Madison, TN 37115
Phone (615) 868-2150
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 17793 | TN | Yes |
Addresses
Primary practice location
2707 Jacksboro Pike
Suite 1a
Jacksboro, TN 37757-2752
Mailing address
1409 Bruce Gap Rd
Caryville, TN 37714-3832
Other providers in Jacksboro, TN
- Mercy Women'S Center
- Frank Townsend Metelka
- Lori M Middleton
- Barbara Milton
- Alissa Dower Miracle
- Jennifer Maria Muggridge
- Laura Kaleigh Mundy
- Myeyedr Optometry of Tennessee, LLC
- Kevin A Mysliwiec
- Sandy L Mysliwiec
All providers in Jacksboro, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.