Active NPI
Timothy Moore
- Registered Nurse
- Batesville, MS
National Provider Identifier
1740688308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R893379
- Practice address
- 120 Randy Hendrix Dr
Batesville, MS 38606-7664 - Phone
- (662) 563-9176
- NPI assigned
- Dec 15, 2014
- Last updated
- Dec 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R893379 | MS | Primary |
Addresses
Primary practice location
120 Randy Hendrix Dr
Batesville, MS 38606-7664
Mailing address
120 Randy Hendrix Dr
Batesville, MS 38606-7664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018204 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R893379 | MS | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418601600000",
"number": "1740688308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 RANDY HENDRIX DR",
"city": "BATESVILLE",
"state": "MS",
"postal_code": "386067664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 RANDY HENDRIX DR",
"city": "BATESVILLE",
"state": "MS",
"postal_code": "386067664",
"telephone_number": "662-563-9176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "TIMOTHY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-15",
"last_updated": "2014-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MS",
"license": "R893379",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00018204",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Batesville, MS
- Mississippi LTAC Holdings, LLC (North Mississippi Specialty Hospital)
- Mississippi Medical Supply, LLC (Mid South Medical & Mobility)
- Mississippi State Department of Health
- Colleen Montgomery
- Natalie Herrington Moore, CFNP
- Crystie Sheree Moorman, PHARMD
- Lukeither Denise Morgan, PCCSS
- Mary J Morrow
- Randall L. Nance, D.O.
- Vynshay Nance
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.