Stephanie L Moore, DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D1108 Issued in MS

Practice address

66 Old Airport Rd
Hattiesburg, MS 39401-8382

Phone

(601) 582-2619

Fax

(601) 544-4557

NPI assigned

Feb 21, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Moore Healthy Family Medical Clinic, LLC

  • Primary Care Clinic/Center
  • Jackson, MS
  • NPI 1205137304
  NPD

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

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203552000000",
    "number": "1760651947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-582-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 OLD AIRPORT RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018382",
            "telephone_number": "601-582-2619",
            "fax_number": "601-544-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEPHANIE",
        "middle_name": "L",
        "credential": "DIETITIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-21",
        "last_updated": "2008-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MS",
            "license": "D1108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Scianna Moore, CPNP-PC
• Makenna Elise Moore, MD
• Margaret B Moore, SLP
• Martin Moore Jr.
• Nicole Jones Moore, NP
• Zoe Moore, DO
• Katrina Lynne Morace
• Camryn Morel
• Danielle Morel, FNP
• Carrie Ellen Morgan, PHD

• Registered Dietitian in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Registered Dietitian in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; 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.