Kelley B Moule, MSW, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C9980 Issued in MS

Practice address

911 Ellis Ave
Jackson, MS 39209-6256

Phone

(601) 533-7016

NPI assigned

Oct 20, 2010

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Street Health Physicians Group of Mississippi, LLCGroup PAC ID 7012334170, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Oak Street Health Physicians Group of Mississippi, LLC

  • Family Medicine Physician
  • Raymond, NH
  • NPI 1235754995

  MS

  Medicare reassignment Care Compare group NPD
• McFatter Family Medical, LLC

  • Urgent Care Clinic/Center
  • Ridgeland, MS
  • NPI 1811660293
  NPD (past)

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1689984916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746085",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746085",
            "telephone_number": "773-352-1515",
            "fax_number": "312-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 ELLIS AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392096256",
            "telephone_number": "601-533-7016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Palmetto Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "SC",
            "postal_code": "290727872",
            "country_code": "US",
            "telephone_number": "803-996-1500",
            "fax_number": "803-996-1510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Plaza Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391805187",
            "country_code": "US",
            "telephone_number": "205-246-5690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3600 Bluecutt Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MS",
            "postal_code": "397051397",
            "country_code": "US",
            "telephone_number": "205-246-5690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 N State St Ste 455",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392022000",
            "country_code": "US",
            "telephone_number": "601-957-7343",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4541 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392065308",
            "country_code": "US",
            "telephone_number": "601-533-7017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOULE",
        "first_name": "KELLEY",
        "middle_name": "B",
        "credential": "MSW, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-20",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "9101",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C9980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Linda Moss, M.D.
• Matthew C Moss, MD
• Sherita Moss
• Mina Leigh Motakhaveri
• Marketa R Motton, LPC
• Asmaa Moussa
• Naji Elias Moussa, M.D.
• Mr Discount Drugs
• Ms Children'S Home Society
• Ms Methodist Hospital & Rehabilitation Center

• Clinical Social Worker in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; 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.