Individual provider Active NPI

Katie Dockery Moser, LCSW

  • Clinical Social Worker
  • Yadkinville, NC
National Provider Identifier
1760833842
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C011600 Issued in NC
Practice address
320 E Lee Ave
Yadkinville, NC 27055-8132
Phone
(336) 589-8059
NPI assigned
Jun 29, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P010618 NC
Clinical Social Worker 1041C0700X C011600 NC Primary

Addresses

Primary practice location

320 E Lee Ave
Yadkinville, NC 27055-8132

Mailing address

284 Executive Park Dr Ste 100
Concord, NC 28025-1833
Phone (704) 939-1100

Other names 1

  • Katie Lynn Dockery Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20240404000246 NC Practitioner - Clinical Social Worker 9537412986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Daymark Recovery Services IncGroup PAC ID 0547233975, 132 clinicians

Practice addresses (Care Compare)

320 E Lee Ave
Yadkinville, NC 27055-8132
Phone (336) 679-8805

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P010618NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Daymark Recovery Services, Inc. Clinical CurrentSince Feb 18, 2024 Accepting new patients

Locations

284 Executive Park Dr
Ste 100
Kannapolis, NC 28025
Phone (704) 939-1118

1104A S Main St
Lexington, NC 27292
Phone (336) 300-8836

2129 Statesville Blvd
Salisbury, NC 28147
Phone (704) 633-3616

227 N Main St
Troy, NC 27371
Phone (910) 572-3681

320 E Lee Ave
Yadkinville, NC 27055
Phone (336) 679-8805

Interoperability endpoints

  • Direct secure messaging: katie.dockerymoser.p1@direct.daymarkrecovery.nextgenshare.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1760833842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E LEE AVE",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270558132",
            "telephone_number": "336-589-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSER",
        "first_name": "KATIE",
        "middle_name": "DOCKERY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P010618",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "DOCKERY",
            "middle_name": "LYNN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Yadkinville, NC

Sources for this page

Verify at the official NPI Registry.