Jacqueline Marie Moore, MSN, PMHNP-BC, RN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

60911808 Issued in WA

Practice address

701 NE 136TH Ave Ste 200
Vancouver, WA 98684-6937

Phone

(360) 322-4711

Fax

(360) 583-6404

NPI assigned

Nov 29, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

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.

• Jacqueline Moore PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Vancouver, WA
  • NPI 1093602906

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1598235889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 NE 136TH AVE STE 200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846937",
            "telephone_number": "360-322-4711",
            "fax_number": "360-583-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 NE 136TH AVE STE 200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846937",
            "telephone_number": "360-322-4711",
            "fax_number": "360-583-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSN, PMHNP-BC, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-29",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "60911808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Jane Moore, CSWA
• Dana Moore, MOT, OTR/L
• David Moore
• Diane Marie Moore, LMHCA
• Eric Moore, PTA
• Joshua Moore, LMHCA
• Joshua Michael Moore
• Julieanna Rose Moore, LMP
• Kristina Marie Moore, BS
• Lawrence Harold Moore, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; 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.