Active NPI
Mary Moore, CRNA
- Certified Registered Nurse Anesthetist
- Big Stone Gap, VA
National Provider Identifier
1912010166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0024049167
- Practice address
- 1980 Holton Ave E
Big Stone Gap, VA 24219-3366 - Phone
- (276) 523-3111
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 0024049167 | VA | Primary |
Addresses
Primary practice location
1980 Holton Ave E
Big Stone Gap, VA 24219-3366
Mailing address
999 Executive Park Blvd
Suite 201
Kingsport, TN 37660-4632
Phone (423) 224-3250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74012436 | Medicaid | KY |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024049167 | VA | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196294400000",
"number": "1912010166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "999 EXECUTIVE PARK BLVD",
"address_2": "SUITE 201",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604632",
"telephone_number": "423-224-3250",
"fax_number": "423-224-3258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1980 HOLTON AVE E",
"city": "BIG STONE GAP",
"state": "VA",
"postal_code": "242193366",
"telephone_number": "276-523-3111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MARY",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2007-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "VA",
"license": "0024049167",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "74012436",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Stone Gap, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.