Active NPI
Candace L Moore, PA-C
- Medical Physician Assistant
- Las Vegas, NV
National Provider Identifier
1568555282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA940
- Practice address
- 2650 N Tenaya Way Ste 301
Las Vegas, NV 89128 - Phone
- (702) 870-2099
- Fax
- (702) 869-5347
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA940 | NV | Primary |
Addresses
Primary practice location
2650 N Tenaya Way Ste 301
Las Vegas, NV 89128
Mailing address
PO Box 98978
Las Vegas, NV 89193-8978
Phone (702) 870-2099
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | NV |
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Just 4 Kids Health LLC | Past | Accepting new patients | |
| Just 4 Kids Health LLC | Past | Accepting new patients | |
| Mountain View Hospital Physician Organization | Past | Accepting new patients | |
| Intermountain Medical Holdings Nevada Inc | Past | Accepting new patients |
Organizations & group practices 4
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.
-
dba Intermountain Health
- Internal Medicine Physician
- Henderson, NV
- NPI 1245997279
-
dba Just 4 Kids Urgent Care
- Urgent Care Clinic/Center
- Idaho Falls, ID
- NPI 1043722259
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1073834529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535500800000",
"number": "1568555282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 98978",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891938978",
"telephone_number": "702-870-2099",
"fax_number": "702-869-5347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 N TENAYA WAY STE 301",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89128",
"telephone_number": "702-870-2099",
"fax_number": "702-869-5347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CANDACE",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2018-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NV",
"license": "PA940",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.