JACQUELINE HISTORIAN MOORE (NPI# 1659649002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659649002 |
| Entity Type | Individual |
| Full Name | JACQUELINE HISTORIAN MOORE |
| Credential | LPN |
| Practice Address |
6256 Hillandale Dr Apt 803 Lithonia GA 30058-2432 |
| Practice Telephone | 6789137277 |
| Mailing Telephone | 6789137277 |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2014-01-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | LPN085771 | GA | Nursing Service 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 |
| 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 |
| 1245705631 | Jacqueline Moore | Peer Specialist | 2600 Sw Holden St, Seattle, WA 98126-3505 | 2018-10-11 |
| Street Address |
6256 HILLANDALE DR APT 803 |
| City | LITHONIA |
| State | GA |
| Zip Code | 30058-2432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821603606 | Sherenda Lashawn Ellis | Contractor | 1859 Petite Lane, Lithonia, GA 30058 | 2020-09-09 |
| 1477186807 | Reset Recovery Health Center LLC | Substance Abuse Rehabilitation Facility | 6978 Main St, Lithonia, GA 30058 | 2020-02-13 |
| 1346726122 | Myorganics | Spec/Tech, Pathology | 5910 Shadow Rock Dr, Lithonia, GA 30058 | 2018-07-16 |
| 1699251884 | Enriching Medical Transport | Ambulance | 2260 Lithonia Industrial Blvd., Ste N-b, Lithonia, GA 30058 | 2018-07-11 |
| 1841789914 | Milner Vein and Vascular LLC | Surgery | 5700 Hillandale Dr Ste 150, Lithonia, GA 30058 | 2018-05-04 |
| 1215451265 | Brittany Rawlings | Home Health | 6127 Howell Ridge, Lithonia, GA 30058 | 2017-08-01 |
| 1982125571 | Bella Intellectum, LLC | Technician/Technologist | 6803 Edmonton Ct., Lithonia, GA 30058 | 2017-07-05 |
| 1528589397 | Arlene Dennis | Registered Nurse | 6022 Arnor Links Road, Lithonia, GA 30058 | 2017-07-03 |
| 1417401746 | Two Caring Hands Private Home Care | Home Health | 1959 Singers Way, Lithonia, GA 30058 | 2016-08-03 |
| 1518347467 | Ortho Injury and Wellness Center Inc. | Clinic/Center | 6148 A Covington Hwy, Lithonia, GA 30058 | 2015-06-05 |
| Find all providers in zip 30058 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750890216 | Marcus Dionte Brown | Licensed Practical Nurse | 5003 Wesley Providence Pkwy, Lithonia, GA 30038-6950 | 2017-09-27 |
| 1104233444 | Monica Jones | Licensed Practical Nurse | 7043 Setters Way, Lithonia, GA 30038-7502 | 2014-07-18 |
| 1932527165 | Vaniece Noble | Licensed Practical Nurse | 6796 Mahonia Pl, Lithonia, GA 30038-7537 | 2014-04-04 |
| 1033544184 | Vickie J Ivey | Licensed Practical Nurse | 3410 Rocky Pine Ct, Lithonia, GA 30038-2851 | 2013-09-09 |
| 1386992055 | Roszina Tekola Holmes | Licensed Practical Nurse | 6590 Alford Way, Lithonia, GA 30058-6195 | 2012-08-28 |
| 1265711519 | Valeria Dixon Powell | Licensed Practical Nurse | 4641 Forest Creek Ln, Lithonia, GA 30038-4293 | 2011-08-04 |
| 1952607814 | Rossalind Brown | Licensed Practical Nurse | 2305 Benson Rdg, Lithonia, GA 30058-6526 | 2011-02-09 |
| 1750557187 | Phedeline Nicholas | Licensed Practical Nurse | 1746 Pleasant Hill Trl, Lithonia, GA 30058-5819 | 2008-05-06 |
| 1003167669 | Ayanna Tenay Harris | Licensed Practical Nurse | 2277 Stone Mountain Lithonia Rd, Lithonia, GA 30058-5252 | 2012-09-24 |
| 1316017882 | Joan Elaine Ellis-english | Licensed Practical Nurse | 2277 Stone Mountain Lithonia Rd, Lithonia, GA 30058-5252 | 2006-11-09 |
| Find all providers in LITHONIA | ||||
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| 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.