Tiffany Palertree Moore – Speech-Language Pathologist

Key facts

NPI: 1891334702
Entity type: Individual (NPI type 1)
Primary specialty: Speech-Language Pathologist 235Z00000X
License: S3844 (MS)
Practice address: 131 Public Square
Bruce, MS 38915
Phone: (662) 983-2929
Fax: (877) 546-7610
NPI assigned: Dec 26, 2019
Sex: Female
Sole proprietor: No

Organizations & group practices 2

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.

LTC Therapy Solutions, LLC Preferred Provider Organization · Tupelo, MS · NPI 1821223298

NPD
Reconnect Wellness Bruce LLC Preferred Provider Organization · Bruce, MS · NPI 1396286456

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
S3844	MS	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
LTC Therapy Solutions, LLC		Current since Dec 29, 2019	Accepting new patients
Reconnect Wellness Bruce LLC		Past since Dec 29, 2019	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Speech-Language Pathologist	235Z00000X	S3844	MS	Yes

Addresses

Primary practice location

131 Public Square
Bruce, MS 38915

Mailing address

2801 W Main St
Tupelo, MS 38801-3001
Phone (662) 610-0681

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 26, 2019.

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1891334702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 W MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013001",
            "telephone_number": "662-610-0681",
            "fax_number": "877-546-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 PUBLIC SQUARE",
            "city": "BRUCE",
            "state": "MS",
            "postal_code": "38915",
            "telephone_number": "662-983-2929",
            "fax_number": "877-546-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TIFFANY",
        "middle_name": "PALERTREE",
        "name_prefix": "Ms.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-26",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S3844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bruce, MS

All providers in Bruce, MS · Speech-Language Pathologist in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.