Individual provider Active NPI

Kristie Moore

  • Family Nurse Practitioner
  • Eagan, MN
National Provider Identifier
1801290242
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN191998 Issued in GA
Practice address
PO Box 211699
Eagan, MN 55121-3699
Phone
(866) 849-0692
NPI assigned
Oct 14, 2014
Last updated
Oct 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN191998 GA Primary
Family Nurse Practitioner 363LF0000X 0024198559 VA

Addresses

Primary practice location

PO Box 211699
Eagan, MN 55121-3699

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141201001633 GA Practitioner - Nurse Practitioner 7810219961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Hospital IncGroup PAC ID 1254628092, 14 clinicians

Practice addresses (Care Compare)

3 Hidden Creek Dr
Guyton, GA 31312-4590
Phone (912) 772-8620

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
RN191998GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Effingham Hospital, Inc. CurrentSince Dec 4, 2016 Accepting new patients
Effingham Hospital, Inc. CurrentSince Dec 4, 2016 Accepting new patients
Effingham Hospital, Inc. Past Accepting new patients
Effingham Hospital, Inc. Past Accepting new patients
Effingham Hospital, Inc. Past Accepting new patients

Locations

3 Hidden Creek Dr
Guyton, GA 31312
Phone (912) 772-8620

7306 State Highway 21
Ste 105
Port Wentworth, GA 31407
Phone (912) 826-1500

800 Towne Park Dr
Ste 100
Rincon, GA 31326
Phone (912) 826-0052

100 Goshen Rd
Rincon, GA 31326
Phone (912) 826-6000

520 W 3rd St
Springfield, GA 31329
Phone (912) 826-7337

459 Highway 119 S
Springfield, GA 31329
Phone (912) 754-0200

1451 Highway 21 S
Ste H
Springfield, GA 31329
Phone (912) 754-1035

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790899200000",
    "number": "1801290242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KRISTIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN191998",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024198559",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.