Mary Maudeana Moore, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-117717 Issued in AL

Practice address

10 Missile Ave
Minot AFB, ND 58705-5003

Phone

(701) 723-5190

Fax

(701) 723-5391

NPI assigned

Oct 1, 2014

Last updated

Nov 6, 2023By the provider in NPPES

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Family Care Inc

  • Urgent Care Clinic/Center
  • Florence, AL
  • NPI 1023447943
  Medicare reassignment NPD
• Alabama Mso LLC

  • Family Medicine Physician
  • Cullman, AL
  • NPI 1740073980
  Medicare reassignment NPD
• Eastern Hospital Medicine PC

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1104859123
  Medicare reassignment NPD
• Medical Director Services PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Princess Anne, MD
  • NPI 1871955807

  AL

  Medicare reassignment NPD
• Russellville Hospital Inc

  dba Russellville Hospital Medical Clinic

  • Family Medicine Physician
  • Russellville, AL
  • NPI 1780232314
  Medicare reassignment NPD
• Advantage Family Care, Inc.

  dba Huntsville Hospital Urgent Care

  • Rural Health Clinic/Center
  • Athens, AL
  • NPI 1518674936
  NPD
• Eastern Hospital Medicine PC

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1982418141
  NPD
• Russellville Hospital Inc

  dba Russellville Hospital Family Care First Clinic

  • Rural Health Clinic/Center
  • Russellville, AL
  • NPI 1508491093
  NPD
• Green Country Infectious Disease PC

  • Infectious Disease Physician
  • Broken Arrow, OK
  • NPI 1639639321
  NPD (past)

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1689077927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 RIVER RD APT E207",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356611338",
            "telephone_number": "918-661-6180",
            "fax_number": "256-325-6724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MISSILE AVE",
            "city": "MINOT AFB",
            "state": "ND",
            "postal_code": "587055003",
            "telephone_number": "701-723-5190",
            "fax_number": "701-723-5391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 S 40th St",
            "address_purpose": "LOCATION",
            "city": "Muskogee",
            "state": "OK",
            "postal_code": "744014915",
            "country_code": "US",
            "telephone_number": "918-683-0753",
            "fax_number": "918-683-5677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "MAUDEANA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "114792",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-117717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200558940A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mary.moore.1@3038.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "12205 County Line Rd Ste B",
            "city": "Madison",
            "state": "AL",
            "country_code": "US",
            "postal_code": "357587720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jonathan Martinez
• Michael D McCarthy, SOCIAL WORKER
• Kyle McKelvey, DMD
• Minot Public Schools
• Karen Marie Moffitt, LICSW, CMSW, LCSW
• Megan Nelson, RN
• Anthony Nielsen
• Jasmine Gianni Nurse, WHNP- BC
• Scott Edward Olech, R.PH.
• Amanda Shermaine Oliver, DO

• Family Nurse Practitioner in Minot AFB, ND
• Providers in Minot AFB, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.