Sandra Lee Moore, AGACNP, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

124033 Issued in AR

Practice address

609 W Maple Ave
Springdale, AR 72764-5335

Phone

(479) 757-1260

NPI assigned

Jul 3, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sandra.moore.1@2229.direct.athenahealth.com

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.

• Advanced Aesthetics & Wellness Center PA, Earlmd Family Medicine PA

  • Family Medicine Physician
  • Bentonville, AR
  • NPI 1811135809
  NPD (past)

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

{
    "created_epoch": "1593734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1710504931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8140 OZARK RIDGE DR",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727566325",
            "telephone_number": "479-387-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 W MAPLE AVE",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727645335",
            "telephone_number": "479-757-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SANDRA",
        "middle_name": "LEE",
        "credential": "AGACNP, APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-03",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "124033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sandra.moore.1@2229.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "609 W Maple Ave",
            "city": "Springdale",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727645335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Layne Alexander Moore, PHARM.D.
• Mikiah Moore
• Noah Seth Moore
• Olga Leonor Moore, MHPP
• Rhys C Moore, PHARMD
• Sarah Moore, RN
• Patrick Moran, DDS
• Bryan Moreno
• Ashton T Morey
• Asher Morgan

• Acute Care Nurse Practitioner in Springdale, AR
• Providers in Springdale, AR by specialty
• Acute Care Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.