Active NPI
Nicole E. Moore
- Family Medicine Physician
- Milton, DE
National Provider Identifier
1992457147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- LG-0011888
- Practice address
- 424 Mulberry St
Milton, DE 19968-1628 - Phone
- (302) 684-0561
- NPI assigned
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | L1-0048126 | DE | |
| Family Medicine Physician | 207Q00000X | LG-0011888 | DE | Primary |
Addresses
Primary practice location
424 Mulberry St
Milton, DE 19968-1628
Mailing address
424 Mulberry St
Milton, DE 19968-1628
Phone (302) 684-0561
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nmoore@pacpediatrics.com |
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)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L1-0048126 | DE | MD | Registered Nurse |
| LG-0011888 | DE | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Pediatric & Adolescent Center | Past | Accepting new patients |
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.
-
- Specialist
- Lewes, DE
- NPI 1548344849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644192000000",
"number": "1992457147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 MULBERRY ST",
"city": "MILTON",
"state": "DE",
"postal_code": "199681628",
"telephone_number": "302-684-0561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 MULBERRY ST",
"city": "MILTON",
"state": "DE",
"postal_code": "199681628",
"telephone_number": "302-684-0561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "NICOLE",
"middle_name": "E.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-19",
"last_updated": "2022-02-07",
"certification_date": "2022-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "DE",
"license": "L1-0048126",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "DE",
"license": "LG-0011888",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nmoore@pacpediatrics.com",
"affiliation": "N",
"address_1": "424 Mulberry St",
"city": "Milton",
"state": "DE",
"country_code": "US",
"postal_code": "199681628",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Milton, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.