Jacqueline H Moder

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN240089 Issued in GA

Practice address

1912 Memorial Dr Ste E
Waycross, GA 31501-0989

Phone

(912) 283-7100

NPI assigned

Jul 24, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1568071777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6115 COTTONWOOD LN",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315165992",
            "telephone_number": "912-286-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 MEMORIAL DR STE E",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315010989",
            "telephone_number": "912-283-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODER",
        "first_name": "JACQUELINE",
        "middle_name": "H",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11006710",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN240089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalie Jean Minchew, PHARMD
• Caleb Mingo, CAA
• Miss Jos PCH
• Michelle Mitchell, CCC-SLP
• Erin Holcomb Mixon, AUD
• Martha Lou Molina
• Andrea D Moody, N.P.
• Janna Mullis Moody, APRN
• Lauran Elizabeth Moore, BS, HAD
• Dana Marie Morgan, FNP-BC, PMHNP-BC

• Nurse Practitioner in Waycross, GA
• Providers in Waycross, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.