Jacelyn Jenise Moore, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-22-208872 Issued in GA

Practice address

2945 Walton Way
Augusta, GA 30909-3827

Phone

(706) 842-3279

Fax

(706) 832-3273

NPI assigned

Apr 13, 2022

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not 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.

• Pediatric Autism Clinical & Evaluation Services LLC

  • Clinical Psychologist
  • Augusta, GA
  • NPI 1689198194

  Behavior Technician

  NPD

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1720720329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309093827",
            "telephone_number": "706-842-3279",
            "fax_number": "706-832-3273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309093827",
            "telephone_number": "706-842-3279",
            "fax_number": "706-832-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACELYN",
        "middle_name": "JENISE",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-22-208872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pacesllc@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2945 Walton Way",
            "city": "Augusta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "309093827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donna B. Moore, MD
• Elizabeth Moore
• Elliott Matthew Moore
• Fletcher Stuart Moore, M.D.
• Gabrielle Mara Moore, MD
• John Michael Moore, LAPC
• Kelli Michelle Moore, CTRS
• Laura Moore, M.ED. CCC-SLP
• Lindsay Moore, NP
• Nicole Moore, RD

• Behavior Technician in Augusta, GA
• Providers in Augusta, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.