Kelly Marie Moore, APRN, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

109418 Issued in OK

Practice address

550 W Shawnee St
Muskogee, OK 74401-4144

Phone

(918) 935-3636

NPI assigned

Apr 29, 2019

Sex

Female

Sole proprietor

Yes

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

Enrolled in OK

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

Williams Medical Group Practice, LLCGroup PAC ID 3375832157, 212 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Williams Medical Group Practice, LLC

  • Family Medicine Physician
  • Lawton, OK
  • NPI 1346608809

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Williams Medical Group Practice, LLC

  • Rural Health Clinic/Center
  • Collinsville, OK
  • NPI 1215751508
  NPD

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1629632229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W SHAWNEE ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014144",
            "telephone_number": "918-910-5186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W SHAWNEE ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014144",
            "telephone_number": "918-935-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN, NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-29",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OK",
            "license": "R0109418",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "109418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tom Montgomery III
• Stephanie Moore-Jordan, LMSW
• Deanna Matthews Moore, RN
• Donna Michelle Moore
• Jamison Cary Moore, DPH
• Patsy Moore
• Tamara Moore, RN
• Tracey Rae Moore
• Morgan 24 Hour Medical Escort, LLC
• Shirley Morgan-Glenn

• Family Nurse Practitioner in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.