Mary Sue Moore, PMHNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN9162481 Issued in FL

Practice address

401 Cecil G Costin Sr Blvd
Port St Joe, FL 32456-1928

Phone

(850) 229-1043

NPI assigned

Dec 22, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pancare of Florida, IncGroup PAC ID 3476574229, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, 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 and National Provider Directory roles.

• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Panama City, FL
  • NPI 1366456287
  Medicare reassignment Care Compare group NPD
• Calhoun-Liberty Hospital Association Inc

  • Emergency Care Clinic/Center
  • Blountstown, FL
  • NPI 1649596784
  Medicare reassignment NPD
• Small Hospital Innovations LLC

  • Emergency Medicine Physician
  • Clewiston, FL
  • NPI 1184040560
  Medicare reassignment NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  NPD
• Calhoun Liberty Hospital Association, Inc.

  • Critical Access Hospital
  • Blountstown, FL
  • NPI 1437253085
  NPD (past)
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Panama City, FL
  • NPI 1033922984
  NPD (past)
• Pancare of Florida, Inc

  dba PanCare Rx Chipley

  • Community/Retail Pharmacy
  • Chipley, FL
  • NPI 1093528895
  NPD (past)
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Bristol, FL
  • NPI 1275346108
  NPD (past)
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Blountstown, FL
  • NPI 1316759244
  NPD (past)
• Pancare of Florida, Inc

  • Community/Retail Pharmacy
  • Panama City, FL
  • NPI 1336704196
  NPD (past)
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Bonifay, FL
  • NPI 1578376406
  NPD (past)

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1508221284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11523 SW MCCLELLAN FARM RD",
            "city": "CLARKSVILLE",
            "state": "FL",
            "postal_code": "324303043",
            "telephone_number": "850-899-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CECIL G COSTIN SR BLVD",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324561928",
            "telephone_number": "850-229-1043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20370 NE Burns Ave",
            "address_purpose": "LOCATION",
            "city": "Blountstown",
            "state": "FL",
            "postal_code": "324241045",
            "country_code": "US",
            "telephone_number": "850-674-5411 x214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-22",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9162481",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9162481",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN9162481",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Marie McGill, LPN
• James McMillen, MD
• Robbin Renay Melvin, LPN
• Joshua Mick, MPT
• Amy E. Miller, APRN
• Ann R Morris, RN
• Jill Marlene Nance, LCSW
• Richard Michael Nestrud, M.D.
• New Horizon Primary Care, LLC
• David Joseph Newton, MD

• Family Nurse Practitioner in Port St Joe, FL
• Providers in Port St Joe, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.