SIMONE SHARDAE WILLIAMS MOORE (NPI# 1730602806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730602806 |
| Entity Type | Individual |
| Full Name | SIMONE SHARDAE WILLIAMS MOORE |
| Other Name | SIMONE SHARDAE WILLIAMS |
| Credential | MD |
| Practice Address |
702 Martin Luther King St Mound Bayou MS 38762-9314 |
| Mailing Address |
2500 N State St Jackson MS 39216-4500 |
| Practice Telephone | 6627418800 |
| Practice Fax Number | 6627412700 |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-08-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 27978 | MS | Allopathic & Osteopathic Physicians |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 04501349 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2500 N State St, Jackson, MS 392164500 | 6019845200 | 6019845200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902334782 | Simone Alicia Moore | Registered Nurse | 1301 Carlisle St, Natrona Heights, PA 15065-1152 | 2017-05-24 |
| Street Address |
702 MARTIN LUTHER KING ST |
| City | MOUND BAYOU |
| State | MS |
| Zip Code | 38762-9314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104848787 | Delta Health Center | Clinic/Center | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2006-07-24 |
| 1053921320 | Sarah Shepherd | Counselor | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2020-08-03 |
| 1043841067 | Anthony Louis Oliveri | Physical Medicine & Rehabilitation | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2020-01-29 |
| 1295290872 | Laura Grant | Clinical Exercise Physiologist | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2019-02-07 |
| 1467999318 | Kirsten Westerfield | Dietitian, Registered | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2017-01-30 |
| 1477090728 | Meta H Anderson | Nurse Practitioner | 702 Martin Luther King St, Pob 900, Mound Bayou, MS 38762-9314 | 2017-01-25 |
| 1124474648 | Natural Pain Back Institute, LLC | Chiropractor | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2016-05-13 |
| 1285041038 | Ronsheka A Palmer | Nurse Practitioner | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2014-07-14 |
| 1831523620 | Alyssa Lott Simmons | Nurse Practitioner | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2013-08-28 |
| 1477890911 | Delta Health Center, Inc | Clinic/Center | 702 Martin Luther King St, Mound Bayou, MS 38762-9314 | 2013-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891137873 | Beverly C Johnson | Hospice Care, Community Based | 116 S Edward Avenue, Mound Bayou, MS 38762 | 2013-07-19 |
| 1629310487 | Community Adult Day Care | Clinic/Center | 114 S Edwards Avenue, Mound Bayou, MS 38762 | 2013-03-20 |
| 1235482233 | Melvern Scott Jr. | Social Worker | 109 Rayner Rd, Mound Bayou, MS 38762 | 2012-10-16 |
| 1063692770 | Allison Hailman Doyle | Family Medicine | 702 Mlk St, Mound Bayou, MS 38762 | 2007-11-09 |
| 1578785820 | Mound Bayou Public Schools | Registered Nurse | 202 Mlk, Mound Bayou, MS 38762 | 2007-05-03 |
| 1700923836 | Delta Health Center | Clinic/Center | 702 Martin Luther King Rd, Mound Bayou, MS 38762 | 2007-01-30 |
| 1649363656 | Ki M Chang | Internal Medicine | 7165 Getwell Road, Bldg F, Southaven, MS 38762 | 2006-10-02 |
| 1689033706 | North Bolivar Consolidated School District | Local Education Agency (LEA) | 201 Green St, Mound Bayou, MS 38762 | 2016-02-17 |
| 1144398710 | Delta Health Center | Clinic/Center | 702 Martin Luther King Road, Mound Bayou, MS 38762 | 2006-12-01 |
| 1255545570 | Delta Health Center, Inc. | Clinic/Center | 702 Martin Luther King Road, Mound Bayou, MS 38762-0900 | 2007-05-09 |
| Find all providers in zip 38762 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265049928 | Jillian Christina Smith | Student in an Organized Health Care Education/Training Program | 91570 Highway 42, Richton, MS 39476-9708 | 2020-09-28 |
| 1487261087 | William Andrew Harrelson | Student in an Organized Health Care Education/Training Program | 215 Union Line Rd, Laurel, MS 39443-0772 | 2020-09-28 |
| 1114534922 | Brianna Danielle Morris | Student in an Organized Health Care Education/Training Program | 415 Gatewood Dr, Pearl, MS 39208-4409 | 2020-09-25 |
| 1942817838 | Ebony Symone' Woodson | Student in an Organized Health Care Education/Training Program | 288 Mount Helm Rd, Brandon, MS 39047-8462 | 2020-09-25 |
| 1093322885 | Danna Shaye Jackson | Student in an Organized Health Care Education/Training Program | 115 Howard Heights Rd, Poplarville, MS 39470-7454 | 2020-09-25 |
| 1972110963 | Akira Keyana Baker | Student in an Organized Health Care Education/Training Program | 415 N Ione St, Tupelo, MS 38801-3116 | 2020-09-24 |
| 1043827900 | Carla Odom | Student in an Organized Health Care Education/Training Program | 963 Taylor Rd, Kokomo, MS 39643-4967 | 2020-09-24 |
| 1902413974 | Katharine Bogard | Student in an Organized Health Care Education/Training Program | 2032 Tuilleries Cv, Biloxi, MS 39531-2423 | 2020-09-24 |
| 1023624137 | Daysi Lisett Zanzon | Student in an Organized Health Care Education/Training Program | 210 S Lowe St, Hazlehurst, MS 39083-3017 | 2020-09-23 |
| 1922614171 | Kathleen Michele Tate | Student in an Organized Health Care Education/Training Program | 2412 Meadow Oak, Flowood, MS 39232-8780 | 2020-09-22 |
| Find all providers with the same taxonomy | ||||
| City | MOUND BAYOU |
| Zip Code | 38762 |
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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.