JACQUELINE ELIZABETH MOORE (NPI# 1295017473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295017473 |
| Entity Type | Individual |
| Full Name | JACQUELINE ELIZABETH MOORE |
| Credential | PA-C |
| Practice Address |
4815 Kanawha Ave Sw South Charleston WV 25309-1207 |
| Practice Telephone | 3047684567 |
| Practice Fax Number | 3047682277 |
| Mailing Telephone | 3047684567 |
| Mailing Fax Number | 3047682277 |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
544 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689222754 | Jacqueline Blair Moore | Counselor | 14651 Dallas Pkwy Ste 134, Dallas, TX 75254-8904 | 2019-08-30 |
| 1376103838 | Jacqueline Faith Moore | Marriage & Family Therapist | 5450 Ralston St Ste 101, Ventura, CA 93003-6042 | 2019-06-17 |
| 1033611256 | Jacqueline Moore | Registered Nurse | 314 Main St Ste D, Monticello, MS 39654-3702 | 2018-03-03 |
| 1952655466 | Jacqueline Adele Moore | Massage Therapist | 1048 Spinnaker St, Elgin, IL 60123-8587 | 2012-11-06 |
| 1659649002 | Jacqueline Historian Moore | Licensed Practical Nurse | 6256 Hillandale Dr Apt 803, Lithonia, GA 30058-2432 | 2011-12-13 |
| 1619173838 | Jacqueline Diana Moore | Surgery | 2280 Opitz Blvd Ste 110, Woodbridge, VA 22191-3362 | 2007-06-25 |
| 1962059980 | Jacqueline Moore | Speech-Language Pathologist | 5980 Radio Station Rd, La Plata, MD 20646-3337 | 2019-08-23 |
| 1336702638 | Jacqueline Dyan Moore | Student in an Organized Health Care Education/Training Program | 800 Garfield Ave Rm G102, Parkersburg, WV 26101-5340 | 2019-04-22 |
| 1336702315 | Jacqueline Moore | Developmental Therapist | 6239 S East St Ste A, Indianapolis, IN 46227-2088 | 2019-04-16 |
| 1598235889 | Jacqueline Marie Moore | Nurse Practitioner | 101 E 8th St Ste 110, Vancouver, WA 98660-3294 | 2018-11-29 |
| Street Address |
4815 KANAWHA AVE SW |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699774315 | Michelle Leigh Endicott | Dermatology | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 | 2005-07-14 |
| 1841406766 | Todd Vincent Kreitzer | Dermatology | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 | 2007-05-15 |
| 1174604409 | South Charleston Dermatology Pllc | Dermatology | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841603529 | Timothy Douglas | Physician Assistant | 4202 Mccorkle Ave Sw Ste 200, South Charleston, WV 25309-1513 | 2014-06-10 |
| 1407006323 | Connie Fay Dorfner | Physician Assistant | 18 River Walk Mall, South Charleston, WV 25303-1026 | 2008-09-28 |
| 1972609550 | Anthony B Knell | Physician Assistant | 500 Poplar St Ste 301, South Charleston, WV 25309-1473 | 2006-09-15 |
| 1639100266 | Kristine K Agnew | Physician Assistant | 4607 Maccorkle Ave Sw Ste 206, South Charleston, WV 25309-1364 | 2006-07-05 |
| 1407850332 | Brandy Huss Boyd | Physician Assistant | 215 Southern Woods Dr, South Charleston, WV 25309-8692 | 2005-06-09 |
| 1215491105 | Kelsey Dawn Mathis | Physician Assistant | 401 Division St Ste 306, South Charleston, WV 25309-1455 | 2019-01-25 |
| 1477047314 | Holli Lucia Dalton | Physician Assistant | 4610 Kanawha Ave Sw Ste 200, South Charleston, WV 25309-1367 | 2018-06-14 |
| 1821519398 | Erika B. Saunders | Physician Assistant | 4610 Kanawha Ave Sw Ste 402, South Charleston, WV 25309 | 2017-07-05 |
| 1184014128 | Alice Stanley | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2015-01-29 |
| 1295170587 | Katherine Elizabeth Boggs | Physician Assistant | 4619 Kanawha Avenue Sw, South Charleston, WV 25309 | 2013-05-01 |
| Find all providers in SOUTH CHARLESTON | ||||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
Please comment or provide details below to improve the information on JACQUELINE ELIZABETH MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.