Active NPI
Crystal Baxley Moore
- Prosthetics Case Management
- Elizabethtown, NC
National Provider Identifier
1477084614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- C48738
- Practice address
- 105 East Broad St
Elizabethtown, NC 28337 - Phone
- (910) 991-3151
- NPI assigned
- Mar 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | C48738 | NC | Primary |
Addresses
Primary practice location
105 East Broad St
Elizabethtown, NC 28337
Mailing address
8621 Lisbon Rd
Clarkton, NC 28433-8769
Phone (910) 991-3151
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C48738 | NC | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490054400000",
"number": "1477084614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8621 LISBON RD",
"city": "CLARKTON",
"state": "NC",
"postal_code": "284338769",
"telephone_number": "910-991-3151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 EAST BROAD ST",
"city": "ELIZABETHTOWN",
"state": "NC",
"postal_code": "28337",
"telephone_number": "910-991-3151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CRYSTAL",
"middle_name": "BAXLEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-21",
"last_updated": "2017-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "NC",
"license": "C48738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.